Therapeutic dendrimer

ABSTRACT

Provided herein are dendrimers comprising: a core unit, five generations of building units which are lysine residues or analogues thereof, first terminal groups comprising a cabazitazel residue covalently attached to a diglycolyl linker group, and second terminal groups comprising a PEG group. Also provided herein are pharmaceutical compositions comprising the dendrimers, and methods and uses of the dendrimers in therapy of disorders such as cancers. Processes for making the dendrimers and intermediates are also provided.

REFERENCE TO RELATED APPLICATIONS

This application is a continuation-in-part of U.S. patent applicationSer. No. 17/003,699, which is a continuation of U.S. patent applicationSer. No. 16/933,354, filed Jul. 20, 2020, now abandoned, which is acontinuation of International Patent Application No. PCT/AU2019/050759,filed on Jul. 19, 2019, published as WO 2020/014750 A1, which claims thebenefit of the filing date of Australian Patent Application No.2018902611, filed on Jul. 19, 2018, the entire contents of each of theabove applications are incorporated herein by reference.

FIELD OF THE INVENTION

The present disclosure generally relates to drug-dendrimer conjugatescomprising a dendrimer including a core and building units, theoutermost generation of building units including one or morepharmaceutically active agents attached via a cleavable linker group.The present disclosure also relates to pharmaceutical compositions andmethods of treatment comprising the drug-dendrimer conjugates, and toprocesses and synthetic intermediates for producing the drug-dendrimerconjugates.

BACKGROUND OF THE INVENTION

There are a number of difficulties associated with the formulation anddelivery of pharmaceutically active agents including poor aqueoussolubility, toxicity, low bioavailability, instability under biologicalconditions, lack of targeting to the site of action, and rapid in vivodegradation.

To combat some of these difficulties, pharmaceutically active agents maybe formulated with solubilising agents which themselves may cause sideeffects such as hypersensitivity and may require premedication to reducethese side effects. Alternative approaches include encapsulation of thepharmaceutically active agent in liposomes, micelles or polymer matricesor attachment of the pharmaceutically active agent to liposomes,micelles and polymer matrices.

Although these approaches may improve some of the problems associatedwith the formulation and delivery of pharmaceutically active agents,many still have drawbacks.

Oncology drugs can be particularly difficult to formulate and have sideeffects that may limit the dosage amount and regimen that can be usedfor treatment. This can result in reduced efficacy of the treatment. Forexample, taxane drugs such as cabazitaxel have low aqueous solubility,but also a relatively narrow therapeutic window, and so increasingconcentration of the agent by, for example, using solubilisationexcipients can result in associated toxicity issues.

The use of liposomes, micelles and polymer matrices as carriers, eitherencapsulating or having the pharmaceutical agent attached, whileallowing solubilisation of the pharmaceutically active agent and in somecases improved bioavailability and reduced toxicity, presentdifficulties in relation to release of the pharmaceutically activeagent. In some cases, the carrier degrades rapidly releasing thepharmaceutically active agent before it has reached the target organ. Inother cases, the release of the pharmaceutically active agent from thecarrier is slowed to the extent that a therapeutic dose of drug in thebody or in the target organ may not be attained. Further, suchcompositions may present stability and manufacturing challenges.

Therefore, there is a need for alternative formulations and deliverymeans for delivering drugs to reduce side effects, improve dosageregimens and improved therapeutic window, which may lead to bettercompliance and efficacy of a drug for patients, while being stable, andpractical to manufacture, and having a generally homogenous composition.

SUMMARY OF THE INVENTION

The subject matter of the present disclosure is predicated in part onthe surprising discovery that cabazitaxel, when conjugated to adendrimer, provides improved efficacy and/or pharmacokinetic propertiesof the drug.

Accordingly, in a first aspect there is provided a dendrimer comprising:

i) a core unit (C); and

ii) building units (BU), each building unit being a lysine residue or ananalogue thereof;

wherein the core unit is covalently attached to two building units viaamide linkages, each amide linkage being formed between a nitrogen atompresent in the core unit and the carbon atom of an acyl group present ina building unit;

the dendrimer being a five generation building unit dendrimer;

wherein building units of different generations are covalently attachedto one another via amide linkages formed between a nitrogen atom presentin one building unit and the carbon atom of an acyl group present inanother building unit;

iii) a plurality of first terminal groups (T1) comprising a cabazitaxelresidue covalently attached to a diglycolyl linker group; and

iv) a plurality of second terminal groups (T2) comprising a PEG or PEOXgroup;

wherein at least one third of the nitrogen atoms present in outerbuilding units are each covalently attached to a first terminal group;and

at least one third of the nitrogen atoms present in outer building unitsare each covalently attached to a second terminal group;

and wherein the therapeutically effective amount of dendrimeradministered to the subject provides about 20 mg/m² of cabazitaxel.

In some embodiments, the core is:

In some embodiments, the building units are each:

wherein the acyl group of each building unit provides a covalentattachment point for attachment to the core or to a previous generationbuilding unit; and wherein each nitrogen atom provides a covalentattachment point for covalent attachment to a subsequent generationbuilding unit, a first terminal group or a second terminal group.

In some embodiments, each first terminal group (T1) is:

In some embodiments, the second terminal groups are each

and wherein the PEG group is a methoxy-terminated PEG having an averagemolecular weight in the range of from about 1750 to 2500 Daltons.

In some embodiments, the dendrimer comprises surface units comprising anouter building unit attached to a first terminal group and a secondterminal group, the surface units having the structure:

In some embodiments, the dendrimer has from 28 to 32 surface units,preferably from 30 to 32 surface units.

In some embodiments, the five generations of building units are completegenerations, and wherein the outer generation of building units provides64 nitrogen atoms for covalent attachment to a first terminal group or asecond terminal, wherein from 26 to 32 first terminal groups arecovalently attached to one of said nitrogen atoms, and wherein from 28to 32 second terminal groups are each covalently attached to one of saidnitrogen atoms.

In some embodiments, the cabazitaxel residues comprise a w/w % of thedendrimer in the range of from 23% w/w to 28% w/w.

In some embodiments, the dendrimer is:

in which T1′ represents a first terminal group which is

or T1′ represents H, wherein less than 5 of T1′ are H; andT2′ represents a second terminal group which is

wherein the PEG group is a methoxy-terminated PEG having an averagemolecular weight in the range of from about 1750 to 2500 Daltons, or T2′represents H, and wherein less than 5 of T2′ are H.

In some embodiments, the cancer is selected from the group consisting ofpancreatic cancer, prostate cancer, breast cancer, ovarian cancer,gastro-oesophageal cancer, thymic cancer, hepatobiliary cancer, head andneck squamous cell carcinomas, non-small cell lung carcinoma, cervicalcancer, and digital papillary adenocarcinoma.

In some embodiments, the ovarian cancer is a granulosa cell cancer.

In some embodiments, the gastro-oesophageal cancer is agastro-oesophageal junction adenocarcinoma or an oesophageal squamouscell carcinoma.

In some embodiments, the hepatobiliary cancer is a cholangiocarcinoma.

In some embodiments, the prostate cancer is selected from the groupconsisting of bone metastatic prostate cancer, prostatic neoplasms,hormone-refractory prostate cancer, metastatic castration-resistantprostate cancer, and advanced prostate cancer.

In some embodiments, the prostate cancer is metastaticcastration-resistant prostate cancer.

In some embodiments, the dendrimer is administered as an infusion over atime period of up to 60 minutes, or wherein the dendrimer isadministered as a bolus over a time period of up to 5 minutes.

In some embodiments, the dendrimer is administered in combination with afurther therapeutic agent.

In some embodiments, the further therapeutic agent is a furtheranti-cancer drug.

In some embodiments, administration of the dendrimer provides enhancedclinical efficacy in comparison to administration of 20 mg/m² of freecabazitaxel.

In some embodiments, administration of a course of the dendrimerprovides enhanced clinical efficacy in comparison to three-weeklyadministration of 20 mg/m² of free cabazitaxel.

In some embodiments, administration of the dendrimer provides areduction in a side effect selected from the group consisting ofalopecia, leukopenia, asthenia, haematuria, neutropenia, lymphopenia,anemia, and thrombocytopenia, in comparison to administration of 20mg/m² of free cabazitaxel.

In some embodiments, administration of the dendrimer provides areduction in a Grade 3 or 4 side effect/adverse effect.

In some embodiments, administration of the dendrimer provides areduction in neutropenia in comparison to administration of 20 mg/m² offree cabazitaxel.

In some embodiments, the subject has not received primary granulocytecolony stimulating factor (G-CSF) prophylaxis.

In some embodiments, the age of the subject is at least about 65, about70, or about 80 years.

In some embodiments, the age of the subject is at least about 65 years.

In some embodiments, the cancer is metastatic castration-resistantprostate cancer and the subject has not received primary granulocytecolony stimulating factor (G-CSF) prophylaxis.

In some embodiments, the age of the subject is at least about 65 years.

In some embodiments, the dendrimer is administered as a pharmaceuticalcomposition.

In some embodiments, the pharmaceutical composition comprises apharmaceutically acceptable excipient.

In some embodiments, the composition further comprises trehalose andcitric acid.

In a further aspect, there is provided a process for producing adendrimer as defined herein, comprising:

a) reacting a cabazitaxel intermediate which is:

wherein X is —OH or a leaving group, or wherein X together with the C(O)group to which it is attached forms a carboxylate salt;

with a dendrimeric intermediate which comprises:

i) a core unit (C); and

ii) building units (BU), each building unit being a lysine residue or ananalogue thereof;

wherein the core unit is covalently attached to two building units viaamide linkages, each amide linkage being formed between a nitrogen atompresent in the core unit and the carbon atom of an acyl group present ina building unit;

the dendrimer being a five generation building unit dendrimer;

wherein building units of different generations are covalently attachedto one another via amide linkages formed between a nitrogen atom presentin one building unit and the carbon atom of an acyl group present inanother building unit;

the dendrimer further comprising:

a plurality of second terminal groups (T2) each comprising a PEG group;

wherein at least one third of the nitrogen atoms present in the outerbuilding units are each covalently attached to a second terminal group;

and wherein at least one third of the nitrogen atoms present in theouter building units are unsubstituted and available for reaction withthe first intermediate;

or a salt thereof;

under amide coupling conditions;

or

b) reacting a PEG intermediate which is:

wherein PEG Group is a PEG-containing group, andX is —OH or a leaving group, or wherein X together with the C(O) groupto which it is attached forms a carboxylate salt;

with a dendrimeric intermediate which comprises:

i) a core unit (C); and

ii) building units (BU), each building unit being a lysine residue or ananalogue thereof;

wherein the core unit is covalently attached to two building units viaamide linkages, each amide linkage being formed between a nitrogen atompresent in the core unit and the carbon atom of an acyl group present ina building unit;

the dendrimer being a five generation building unit dendrimer;

wherein building units of different generations are covalently attachedto one another via amide linkages formed between a nitrogen atom presentin one building unit and the carbon atom of an acyl group present inanother building unit;

the dendrimer further comprising:

a plurality of first terminal groups (T1) each comprising a cabazitazelresidue covalently attached to a diglycolyl linker group;

wherein at least one third of the nitrogen atoms present in the outerbuilding units are each covalently attached to a first terminal group;

and wherein at least one third of the nitrogen atoms present in theouter building units are unsubstituted;

or a salt thereof;

under amide coupling conditions;

or

c) reacting a surface unit intermediate which is:

wherein PEG Group is a PEG-containing group, andX is —OH or a leaving group, or wherein X together with the C(O) groupto which it is attached forms a carboxylate salt;

with a dendrimeric intermediate comprising:

i) a core unit (C); and

ii) building units (BU), each building unit being a lysine residue or ananalogue thereof;

wherein the core unit is covalently attached to two building units viaamide linkages, each amide linkage being formed between a nitrogen atompresent in the core unit and the carbon atom of an acyl group present ina building unit;

the dendrimeric intermediate being a four generation building unitdendrimeric intermediate;

wherein building units of different generations are covalently attachedto one another via amide linkages formed between a nitrogen atom presentin one building unit and the carbon atom of an acyl group present inanother building unit;

and wherein nitrogen atoms present in the outer building units of thedendrimeric intermediate are unsubstituted;

or a salt thereof;

under amide coupling conditions.

In a further aspect, there is provided an intermediate for producing adendrimer which is:

wherein X is —OH or a leaving group, or wherein X together with the C(O)group to which it is attached forms a carboxylate salt.

In a further aspect, there is provided an intermediate for producing adendrimer which is

wherein PEG Group is a PEG-containing group, and

X is —OH or a leaving group, or wherein X together with the C(O) groupto which it is attached forms a carboxylate salt.

It will be appreciated that further aspects, embodiments, and examples,are described herein, which may include one or more of the embodimentsor features as described above.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 shows the efficacy of a compound of the present disclosure(SPL9048) and comparator compounds (cabazitaxel, and SPL9005—acomparator cabazitaxel-dendrimer compound) in SCID mice represented bychange in mean tumour volume (TV) (mm³) over time in a prostate cancermodel study.

FIG. 2 shows the mean change in body weight in SCID mice followingadministration of a compound of the present disclosure (SPL9048) andcomparator compounds (cabazitaxel, and SPL9005—a comparatorcabazitaxel-dendrimer compound) over time in a prostate cancer modelstudy.

FIG. 3 shows the efficacy of a compound of the present disclosure(SPL9048) and a comparator compound (cabazitaxel) in SCID micerepresented by change in mean tumour volume (TV) (mm³) over time in abreast cancer tumour model study.

FIG. 4 shows the mean change in body weight in SCID mice followingadministration of a compound of the present disclosure (SPL9048) and acomparator compound (cabazitaxel) over time in a breast cancer modelstudy.

FIG. 5 shows in vivo free-cabazitaxel (released) concentration levelsover time following administration to rats of a compound of the presentdisclosure (SPL9048) and a comparator cabazitaxel-dendrimer compound(SPL9005).

FIG. 6 shows the results of a neutropenia toxicity study data for bothmale and female rats, following administration of a compound of thepresent disclosure (SPL9048) and a comparator compound (Jevtana® brandof cabazitaxel).

FIG. 7 shows the efficacy of a compound of the present disclosure(SPL9048) when dosed alone and in combination with gemcitabine incomparison with comparators gemcitabine, abraxane, and a combination ofgemcitabine and abraxane, in female NOD-scid Interleukin 2 receptorgamma chain null mice, represented by change in mean tumour volume (TV)(mm³) over time in a pancreatic cancer model study.

FIG. 8 shows the levels of a prostate cancer biomarker PSA (μg/L) in apatient having prostate cancer over time.

FIG. 9 shows the levels of an ovarian cancer biomarker CA-125 (μg/L) ina patient having ovarian cancer over time.

DESCRIPTION General Definitions

Unless specifically defined otherwise, all technical and scientificterms used herein shall be taken to have the same meaning as commonlyunderstood by one of ordinary skill in the art (e.g., chemistry,biochemistry, medicinal chemistry, polymer chemistry, and the like).

As used herein, the term “and/or”, e.g., “X and/or Y” shall beunderstood to mean either “X and Y” or “X or Y” and shall be taken toprovide explicit support for both meanings or for either meaning.

As used herein, the term about, unless stated to the contrary, refers to+/−20%, more preferably +/−10%, of the designated value.

As used herein, singular forms “a”, “an” and “the” include pluralaspects, unless the context clearly indicates otherwise.

Throughout this specification, the word “comprise”, or variations suchas “comprises” or “comprising”, will be understood to imply theinclusion of a stated element, integer or step, or group of elements,integers or steps, but not the exclusion of any other element, integeror step, or group of elements, integers or steps.

As used herein, the term “subject” refers to any organism susceptible toa disease or condition. In one embodiment, the disease or condition iscancer. For example, the subject can be a mammal, primate, livestock(e.g., sheep, cow, horse, pig), companion animal (e.g., dog, cat), orlaboratory animal (e.g., mouse, rabbit, rat, guinea pig, hamster). Inone example, the subject is a mammal. In one embodiment, the subject ishuman.

As used herein, the term “treating” includes alleviation of the symptomsassociated with a specific disorder or condition and eliminating saidsymptoms. For example, as used herein, the term “treating cancer” refersto alleviating the symptoms associated with cancer and eliminating saidsymptoms. In one embodiment, the term “treating cancer” refers to areduction in cancerous tumour size. In one embodiment, the term“treating cancer” refers to an increase in progression-free survival. Asused herein, the term “progression-free survival” refers to the lengthof time during and after the treatment of cancer that a patient liveswith the disease, i.e., cancer, but does not have a recurrence orincrease in symptoms of the disease.

As used herein, the term “prevention” includes prophylaxis of thespecific disorder or condition. For example, as used herein, the term“preventing cancer” refers to preventing the onset or duration of thesymptoms associated with cancer. In one example, the term “preventingcancer” refers to slowing or halting the progression of the cancer. Inone example, the term “preventing cancer” refers to slowing orpreventing metastasis.

As would be understood by the person skilled in the art, a dendrimerwould be administered in a therapeutically effective amount. The term“therapeutically effective amount”, as used herein, refers to adendrimer being administered in an amount sufficient to alleviate orprevent to some extent one or more of the symptoms of the disorder orcondition being treated. The result can be the reduction and/oralleviation of the signs, symptoms, or causes of a disease or condition,or any other desired alteration of a biological system. In oneembodiment, the term “therapeutically effective amount” refers to adendrimer being administered in an amount sufficient to result in areduction in cancerous tumour size. In one embodiment, the term“therapeutically effective amount” refers to a dendrimer beingadministered in an amount sufficient to result in an increase inprogression-free survival. The term, an “effective amount”, as usedherein, refers to an amount of a dendrimer effective to achieve adesired pharmacologic effect or therapeutic improvement without undueadverse side effects or to achieve a desired pharmacologic effect ortherapeutic improvement with a reduced side effect profile. By way ofexample only, therapeutically effective amounts may be determined byroutine experimentation, including but not limited to a dose escalationclinical trial. The term “therapeutically effective amount” includes,for example, a prophylactically effective amount. In one embodiment, aprophylactically effective amount is an amount sufficient to preventmetastasis. It is understood that “an effective amount” or “atherapeutically effective amount” can vary from subject to subject, dueto variation in metabolism of the compound and any of age, weight,general condition of the subject, the condition being treated, theseverity of the condition being treated, and the judgment of theprescribing physician. Thus, it is not always possible to specify anexact “effective amount”. However, an appropriate “effective amount” inany individual case may be determined by one of ordinary skill in theart using routine experimentation. Where more than one therapeutic agentis used in combination, a “therapeutically effective amount” of eachtherapeutic agent can refer to an amount of the therapeutic agent thatwould be therapeutically effective when used on its own, or may refer toa reduced amount that is therapeutically effective by virtue of itscombination with one or more additional therapeutic agents.

As used herein, the term “alkyl” refers to straight (i.e., linear) orbranched chain hydrocarbons ranging in size from one to 10 carbon atoms(i.e. C₁₋₁₀alkyl). Thus, alkyl moieties include, unless explicitlylimited to smaller groups, moieties ranging in size, for example, fromabout one to about six carbon atoms or greater, such as, methyl, ethyl,n-propyl, iso-propyl and/or butyl, pentyl, hexyl, and higher isomers. Inone example, the alkyl moiety is of one to 10 carbon atoms (i.e.C₁₋₁₀alkyl). In another example, the alkyl moiety is of 2 to 4 carbonatoms, preferably 4 carbon atoms.

As used herein, the term “alkylene” refers to straight (i.e. linear) orbranched chain hydrocarbons ranging in size from 1 to 10 carbon atoms(i.e. C₁₋₁₀alkylene). Thus, alkylene moieties include, for example,—CH₂—, —CH₂CH₂—, —CH₂CH₂CH₂—, —CH₂CH(CH₃)—, —CH₂CH₂CH₂CH₂—,—CH₂CH(CH₃)CH₂—, and the like.

Suitable salts of the dendrimers include those formed with organic orinorganic acids or bases. As used herein, the phrase “pharmaceuticallyacceptable salt” refers to pharmaceutically acceptable organic orinorganic salts. Exemplary acid addition salts include, but are notlimited to, sulfate, citrate, acetate, oxalate, chloride, bromide,iodide, nitrate, bisulfate, phosphate, acid phosphate, isonicotinate,lactate, salicylate, acid citrate, tartrate, oleate, tannate,pantothenate, bitartrate, ascorbate, succinate, maleate, gentisinate,fumarate, gluconate, glucuronate, saccharate, formate, benzoate,glutamate, methanesulfonate, ethanesulfonate, benzenesulfonate,p-toluenesulfonate, and pamoate (i.e.,1,1′-methylene-bis-(2-hydroxy-3-naphthoate)) salts. Exemplary baseaddition salts include, but are not limited to, ammonium salts, alkalimetal salts, for example those of potassium and sodium, alkaline earthmetal salts, for example those of calcium and magnesium, and salts withorganic bases, for example dicyclohexylamine, N-methyl-D-glucomine,morpholine, thiomorpholine, piperidine, pyrrolidine, a mono-, di- ortri-lower alkylamine, for example ethyl-, tert-butyl-, diethyl-,diisopropyl-, triethyl-, tributyl- or dimethyl-propylamine, or a mono-,di- or trihydroxy lower alkylamine, for example mono-di- ortriethanolamine. A pharmaceutically acceptable salt may involve theinclusion of another molecule such as an acetate ion, a succinate ion orother counterion. The counterion may be any organic or inorganic moietythat stabilizes the charge on the parent compound. Furthermore, apharmaceutically acceptable salt may have more than one charged atom inits structure. Instances where multiple charged atoms are part of thepharmaceutically acceptable salt can have multiple counter ions. Hence,a pharmaceutically acceptable salt can have one or more charged atomsand/or one or more counterion. It will also be appreciated thatnon-pharmaceutically acceptable salts also fall within the scope of thepresent disclosure since these may be useful as intermediates in thepreparation of pharmaceutically acceptable salts or may be useful duringstorage or transport.

Those skilled in the art of organic and/or medicinal chemistry willappreciate that many organic compounds can form complexes with solventsin which they are reacted or from which they are precipitated orcrystallized. These complexes are known as “solvates”. For example, acomplex with water is known as a “hydrate”. As used herein, the phrase“pharmaceutically acceptable solvate” or “solvate” refer to anassociation of one or more solvent molecules and a compound of thepresent disclosure. Examples of solvents that form pharmaceuticallyacceptable solvates include, but are not limited to, water, isopropanol,ethanol, methanol, DMSO, ethyl acetate, acetic acid, and ethanolamine.

As used herein, the term “dendrimer” refers to a molecule containing acore and dendrons attached to the core. Each dendron is made up ofgenerations of branched building units resulting in a branched structurewith increasing number of branches with each generation of buildingunits. A “dendrimer”, including a drug-dendrimer conjugate, may includepharmaceutically acceptable salts or solvates as defined supra.

As used herein, the term “building unit” refers to a branched moleculewhich is a lysine residue or an analogue thereof having three functionalgroups, one for attachment to the core or a previous generation ofbuilding units and at least two functional groups for attachment to thenext generation of building units or forming the surface of thedendrimer molecule.

As used herein, the term “attached” refers to a connection betweenchemical components by way of covalent bonding. The term “covalentbonding”, as used herein, refers to a chemical bond formed by thesharing of one or more electrons, especially pairs of electrons, betweenatoms. The term “covalent bonding” is used interchangeable with the term“covalent attachment”.

As used herein, the term “solubilisation excipient” refers to aformulation additive that is used to solubilise insoluble or sparinglysoluble drugs into an aqueous formulation. Examples include surfactantssuch as polyethoxylated caster oils including Cremophor EL, Cremophor RH40 and Cremophor RH 60, D-α-tocopherol-polyethylene-glycol 1000succinate, polysorbate 20, polysorbate 80, solutol HS 15, sorbitanmonoleate, poloxamer 407, Labrasol and the like.

Jevtana® is manufactured by Sanofi (France), and is an example of freecabazitaxel for comparing to dendrimer. Jevtana® pharmacokinetic datahas been published (see e.g. Mita A C, Denis L J, Rowinsky E K, et al.Phase I and pharmacokinetic study of XRP6258 (RPR 116258A), a noveltaxane, administered as a 1-hour infusion every 3 weeks in patients withadvanced solid tumors. Clin Cancer Res. 2009; 15(2):723-730).

In Mita, the 25-mg/m² dose was correlated with a Cmax of 535±305 mcg/Land an AUC concentration of 642±320 mcg/L per hour. A triphasic modelwas used to describe the drug's decreased plasma concentrations. Theplasma concentration pharmacokinetic activity was characterized by arapid initial elimination phase (average terminal half-life [t½]=2.6±1.4minutes), followed by an intermediate elimination phase (averaget½=1.3±0.6 hours) and a prolonged terminal elimination phase (averaget½=77.3±45.5 hours). Approximately 80% of the dose was eliminated within2 weeks. The volume of distribution at steady state was large and highlyvariable (2,034±1,495 L/m2).

The principal dose-limiting toxicity in this study was hematologicalbone-marrow suppression (i.e., neutropenia). One patient (4%)experienced prolonged grade 4 neutropenia, and a second patient (4%)experienced febrile neutropenia, both with the 25-mg/m2 dose.Nonhematological toxicities also occurred. Two patients (8%) experiencedflushing, dizziness, and chest tightness, which were identified as grade1 hypersensitivity reactions. Other nonhematological toxicities includeddiarrhea (14 patients; 56%), nausea (10 patients; 40%), fatigue (ninepatients; 36%), neurotoxicity (nine patients; 36%), and vomiting (fourpatients; 16%).

In the Phase 3 TROPIC study in patients with metastatic prostate cancer(n=67), the mean Cmax was 226 ng/mL (coefficient of variation, CV 107%)and was reached at the end of the 1-hour infusion (Tmax). The mean AUCwas 991 ng·h/mL (CV: 34%). Neutropenia (all grades) occurred in 94% ofthe cabazitaxel patients and Grade 3 or 4 febrile neutropenia occurredin 8% of the cabazitaxel patients. In the TROPIC registration study forJevtana, after a 1-hour IV administration dose of cabazitaxel at 25mg/m2, (de Bono J S, Oudard S, Ozguroglu M, et al. Prednisone pluscabazitaxel or mitoxantrone for metastatic castration-resistant prostatecancer progressing after docetaxel treatment: A randomised open-labeltrial. Lancet. 2010; 376(9747):1147-1154.)

Dendrimer

In a first aspect. there is provided a dendrimer comprising:

i) a core unit (C); and

ii) building units (BU), each building unit being a lysine residue or ananalogue thereof;

wherein the core unit is covalently attached to two building units viaamide linkages, each amide linkage being formed between a nitrogen atompresent in the core unit and the carbon atom of an acyl group present ina building unit;

the dendrimer being a five generation building unit dendrimer;

wherein building units of different generations are covalently attachedto one another via amide linkages formed between a nitrogen atom presentin one building unit and the carbon atom of an acyl group present inanother building unit;

the dendrimer further comprising:

iii) a plurality of first terminal groups (T1) each comprising acabazitazel residue covalently attached to a diglycolyl linker group;and

iv) a plurality of second terminal groups (T2) each comprising a PEGgroup;

wherein at least one third of the nitrogen atoms present in outerbuilding units are each covalently attached to a first terminal group;and

at least one third of the nitrogen atoms present in outer building unitsare each covalently attached to a second terminal group;

or a pharmaceutically acceptable salt thereof.

The core unit (C) of the dendrimer is covalently attached to twobuilding units via amide linkages, each amide linkage being formedbetween a nitrogen atom present in the core unit and the carbon atom ofan acyl group present in a building unit. Accordingly, the core unit mayfor example be formed from a core unit precursor comprising two aminogroups. Any suitable diamino-containing molecule may be used as the coreunit precursor. In some embodiments, the core unit is:

and may, for example, be formed from a core unit precursor:

having two reactive (amino) nitrogens.

The building units (BU) are lysine residues or analogues thereof, andmay be formed from suitable building unit precursors, e.g. lysine orlysine analogues containing appropriate protecting groups. Lysineanalogues have two amino nitrogen atoms for bonding to a subsequentgeneration of building units and an acyl group for bonding to a previousgeneration of building units or a core. Examples of suitable buildingunits include

wherein the acyl group of each building unit provides a covalentattachment point for attachment to the core or to a previous generationbuilding unit; and wherein each nitrogen atom provides a covalentattachment point for covalent attachment to a subsequent generationbuilding unit, a first terminal group or a second terminal group.

In some preferred embodiments, the building units are each:

wherein the acyl group of each building unit provides a covalentattachment point for attachment to the core or to a previous generationbuilding unit; and wherein each nitrogen atom provides a covalentattachment point for covalent attachment to a subsequent generationbuilding unit, a first terminal group or a second terminal group.

In some preferred embodiments, the building units are each:

wherein the acyl group of each building unit provides a covalentattachment point for attachment to the core or to a previous generationbuilding unit; and wherein each nitrogen atom provides a covalentattachment point for covalent attachment to a subsequent generationbuilding unit, a first terminal group or a second terminal group.

The outermost generation of building units (BU_(outer)) may be formed bylysine or lysine analogue building units as used in the othergenerations of building units (BU) as described above. The outermostgeneration of building units (BU_(outer)) is the generation of buildingunits that is outermost from the core of the dendrimer, i.e., no furthergenerations of building units are attached to the outermost generationof building units (BU_(outer)).

It will be appreciated that the dendrons of the dendrimer may forexample be synthesised to the required number of generations through theattachment of building units (BU) accordingly. In some embodiments eachgeneration of building units (BU) may be formed of the same buildingunit, for example all of the generations of building units may be lysinebuilding units. In some other embodiments, one or more generations ofbuilding units may be formed of different building units to othergenerations of building units.

The dendrimer is a five generation building unit dendrimer. A fivegeneration building unit dendrimer is a dendrimer having a structurewhich includes five building units which are covalently linked toanother, for example in the case where the building units are lysines,it may comprise the substructure:

In some embodiments, the dendrimer has five complete generations ofbuilding units. With a core having two reactive amine groups, such adendrimer will comprise 62 building units (i.e. core unit+2 BU+4 BU+8BU+16 BU+32 BU). However, it will be appreciated that, due to the natureof the synthetic process for producing the dendrimers, one or morereactions carried out to produce the dendrimers may not go fully tocompletion. Accordingly, in some embodiments, the dendrimer may comprisean incomplete generations of building units. For example, a populationof dendrimers may be obtained, in which the dendrimers have adistribution of numbers of building units per dendrimer. In someembodiments, a population of dendrimers is obtained which has a meannumber of building units per dendrimer of at least 55, or at least 56,or at least 57, or at least 58, or at least 59, or at least 60. In someembodiments, a population of dendrimers is obtained in which at least60%, at least 70%, at least 80%, at least 90% or at least 95% of thedendrimers have 55 or more building units. In some embodiments, apopulation of dendrimers is obtained in which at least 60%, at least70%, at least 80%, at least 90% or at least 95% of the dendrimers have60 or more building units.

Each reactive (amino) group of the core represents a conjugation sitefor a dendron comprising one or more generations of building units. Thecore has two reactive (amino) groups, and two dendrons, for thegenerations of building units to be attached.

In some embodiments, each generation of building units in each dendron(X) may be represented by the formula [BU]₂(b-1), wherein b is thegeneration number. A dendron (X) having five complete generations ofbuilding units is represented as [BU]₁-[BU]₂-[BU]₄-[BU]₈-[BU]₁₆.

The dendrimer comprises a plurality of first terminal groups (T1) eachcomprising a cabazitaxel residue covalently attached to a diglycolyllinker group. Each first terminal group (T1) is preferably:

i.e. a cabazitaxel residue covalently attached to a diglycolyl linkervia an ester linkage formed between an oxygen atom present as part ofthe cabazitaxel side-chain and a carbon atom of an acyl group present aspart of the diglycolyl linker. The other acyl group of the diglycolyllinker forms an amide linkage with a nitrogen atom present in an outerbuilding unit. In such embodiments, the cabazitaxel residue is:

Upon in vivo administration, typically the dendrimer releasescabazitaxel, i.e.:

The dendrimer comprises a plurality of second terminal groups (T2) eachcomprising a PEG group. The second terminal group T2 is apharmacokinetic modifying agent. A pharmacokinetic modifying agent is anagent that can modify or modulate the pharmacokinetic profile of thedendrimer or the pharmaceutically active agent (i.e. cabazitaxel) thatthe dendrimer is delivering. The pharmacokinetic modifying agent maymodulate the absorption, distribution, metabolism, excretion and/ortoxicity of the dendrimer of the pharmaceutically active agent. Thepharmacokinetic modifying agent (T2) may influence the rate of releaseof the pharmaceutically active agent, either by slowing or increasingthe rate in which the active agent is released from the dendrimer byeither chemical (e.g., hydrolysis) or enzymatic degradation pathways.The pharmacokinetic modifying agent (T2) may change the solubilityprofile of the dendrimer, either increasing or decreasing the solubilityof the dendrimer in a pharmaceutically acceptable carrier. Thepharmacokinetic modifying agent (T2) may assist the dendrimer indelivering the pharmaceutically active agent to specific tissues (e.g.,tumours). The pharmacokinetic modifying agent (T2) may extend thepharmaceutically active agent half-life by reducing clearance of thedendrimer.

A PEG group is a polyethylene glycol group, i.e. a group comprisingrepeat units of the formula —CH₂CH₂O—. PEG materials used to produce thedendrimer of the present disclosure typically contain a mixture of PEGshaving some variance in molecular weight (i.e., ±10%), and therefore themolecular weight specified is typically an approximation of the averagemolecular weight of the PEG composition. For example, the term“PEG_(˜2100)” refers to polyethylene glycol having an average molecularweight of approximately 2100 Daltons, i.e. ±approximately 10% (i.e.,PEG₁₉₀₀ to PEG₂₃₀₀). Three methods are commonly used to calculate MWaverages: number average, weight average, and z-average molecularweights. As used herein, the phrase “molecular weight” is intended torefer to the weight-average molecular weight which can be measured usingtechniques well-known in the art including, but not limited to, NMR,mass spectrometry, matrix-assisted laser desorption ionization time offlight (MALDI-TOF), gel permeation chromatography or other liquidchromatography techniques, light scattering techniques,ultracentrifugation and viscometry.

In some embodiments, the second terminal groups comprise PEG groupshaving an average molecular weight of between about 200 and 5000Daltons. In some embodiments, the second terminal groups comprise PEGgroups having an average molecular weight of at least 750 Daltons. Insome embodiments, the second terminal groups comprise PEG groups havingan average molecular weight in the range of from 1000 to 2500 Daltons.In some embodiments, the second terminal groups comprise PEG groupshaving an average molecular weight in the range of from 1900 to 2300Daltons. In some embodiments, the second terminal groups comprise PEGgroups having an average molecular weight in the range of from 2000 to2200 Daltons. In some embodiments, the second terminal groups comprisePEG groups having an average molecular weight of about 2100 Daltons.

In some embodiments, the PEG group has a polydispersity index (PDI) ofbetween about 1.00 and about 1.50, between about 1.00 and about 1.25, orbetween about 1.00 and about 1.10. In some embodiments, the PEG grouphas a polydispersity index (PDI) of about 1.05. The term “polydispersityindex” refers to a measure of the distribution of molecular mass in agiven polymer sample. The polydispersity index (PDI) is equal to theweight average molecular weight (M_(w)) divided by the number averagemolecular weight (M_(n)) and indicates the distribution of individualmolecular masses in a batch of polymers. The polydispersity index (PDI)has a value equal to or greater than one, but as the polymer approachesuniform change length and average molecular weight, the polydispersityindex (PDI) will be closer to one.

In some embodiments, the PEG group is a methoxy-terminated PEG.

The PEG group may be attached to the outer building unit via anysuitable means. In some embodiments, a PEG linking group is used toattach the PEG group to the outer building unit. In some embodiments,the second terminal groups each comprise a PEG group covalently attachedto a PEG linking group (L1) via an ether linkage formed between a carbonatom present in the PEG group and an oxygen atom present in the PEGlinking group, and each second terminal group is covalently attached toa building unit via an amide linkage formed between a nitrogen atompresent in a building unit and the carbon atom of an acyl group presentin the PEG linking group. In some embodiments, the second terminalgroups are each

and wherein the PEG group is a methoxy-terminated PEG having an averagemolecular weight in the range of from about 1750 to 2500 Daltons.

In the dendrimers of the present disclosure, at least one third of thenitrogen atoms present in outer building units are each covalentlyattached to a first terminal group; and

at least one third of the nitrogen atoms present in outer building unitsare each covalently attached to a second terminal group.

In some embodiments, the dendrimers have controlled stoichiometry and/ortopology. For example, the dendrimers are typically produced usingsynthetic processes that allow for a high degree of control over thenumber and arrangement of first and second terminal groups present onthe dendrimers. In some embodiments, each functionalised outer buildingunit contains one first terminal group and one second terminal group. Insome embodiments, the dendrimer comprises surface units comprising anouter building unit attached to a first terminal group and a secondterminal group, the surface units having the structure:

and wherein the PEG group is a methoxy-terminated PEG having an averagemolecular weight in the range of from about 1750 to 2500 Daltons. Insome embodiments, the dendrimer has from 28 to 32 surface units. In someembodiments, the dendrimer has from 30 to 32 surface units.

In some embodiments, at least 40% of the nitrogen atoms present in theouter building units are each covalently attached to a first terminalgroup. In some embodiments, at least 45% of the nitrogen atoms presentin the outer building units are each covalently attached to a firstterminal group. In some embodiments, about 50% of the nitrogen atomspresent in the outer building units are each covalently attached to afirst terminal group.

In some embodiments, at least 40% of the nitrogen atoms present in theouter building units are each covalently attached to a second terminalgroup. In some embodiments, at least 45% of the nitrogen atoms presentin the outer building units are each covalently attached to a secondterminal group. In some embodiments, about 50% of the nitrogen atomspresent in the outer building units are each covalently attached to asecond terminal group.

In some embodiments, at least 40% of the nitrogen atoms present in theouter building units are each covalently attached to a first terminalgroup; and at least 40% of the nitrogen atoms present in the outerbuilding units are each covalently attached to a second terminal group.In some embodiments, at least 45% of the nitrogen atoms present in theouter building units are each covalently attached to a first terminalgroup; and at least 45% of the nitrogen atoms present in the outerbuilding units are each covalently attached to a second terminal group.In some embodiments, about 50% of the nitrogen atoms present in theouter building units are each covalently attached to a first terminalgroup; and about 50% of the nitrogen atoms present in the outer buildingunits are each covalently attached to a second terminal group.

In some embodiments, the five generations of building units are completegenerations, and wherein the outer generation of building units provides64 nitrogen atoms for covalent attachment to a first terminal group or asecond terminal, wherein from 26 to 32 first terminal groups arecovalently attached to one of said nitrogen atoms, and wherein from 28to 32 second terminal groups are each covalently attached to one of saidnitrogen atoms. In some embodiments, from 28 to 32 first terminal groupsare each covalently attached to one of said nitrogen atoms. In someembodiments, from 29 to 31 first terminal groups are each covalentlyattached to one of said nitrogen atoms.

In some embodiments, cabazitaxel residues comprise at least 20% w/w ofthe dendrimer, at least 22% w/w of the dendrimer, or at least 24% w/w ofthe dendrimer. In some embodiments, cabazitaxel residues comprise up to30% w/w of the dendrimer, up to 28% w/w of the dendrimer or up to 26%w/w of the dendrimer. In some embodiments, cabazitaxel residues comprisea w/w % of the dendrimer in the range of from 20% w/w to 30% w/w, orfrom 23% w/w to 28% w/w, or from 24% w/w to 26% w/w. The w/w % of thedendrimer which is cabazitaxel residues may be determined by anysuitable means. In some embodiments, the w/w % of the dendrimer which iscabazitaxel residues may be determined by ¹H NMR.

In some embodiments, no more than one quarter of the nitrogen atomspresent in the outer generation of building units are unsubstituted. Insome embodiments, no more than one fifth of the nitrogen atoms presentin said outer generation of building units are unsubstituted. In someembodiments, no more than one sixth of the nitrogen atoms present insaid outer generation of building units are unsubstituted. In someembodiments, no more than one eighth of the nitrogen atoms present insaid outer generation of building units are unsubstituted. In someembodiments, no more than one tenth of the nitrogen atoms present insaid outer generation of building units are unsubstituted.

In some embodiments, no more than 20 nitrogen atoms present in the outergeneration of building units are unsubstituted. In some embodiments, nomore than 10 nitrogen atoms present in the outer generation of buildingunits are unsubstituted. In some embodiments, no more than 5 nitrogenatoms present in the outer generation of building units areunsubstituted. In some embodiments, no more than 3 nitrogen atomspresent in the outer generation of building units are unsubstituted. Insome embodiments, no more than 2 nitrogen atoms present in the outergeneration of building units are unsubstituted. In some embodiments, nomore than 1 nitrogen atom present in the outer generation of buildingunits are unsubstituted. In some embodiments, substantially all of thenitrogen atoms present in the outer generation of building units aresubstituted.

In some embodiments, the dendrimer is:

in which T1′ represents a first terminal group which is

or T1′ represents H, wherein less than 5 of T1′ are H; andT2′ represents a second terminal group which is

wherein the PEG group is a methoxy-terminated PEG having an averagemolecular weight in the range of from about 1750 to 2500 Daltons, or T2′represents H, and wherein less than 5 of T2′ are H.

In some embodiments, the dendrimer has a molecular weight in the rangeof from 50 to 300 kDa. In some embodiments, the dendrimer has amolecular weight in the range of from 75 to 200 kDa. In one example, thedendrimer has a molecular weight in the range of from 90 to 150 kDa.

In some embodiments, the in vitro half-life for cabazitaxel release fromthe dendrimer in PBS (phosphate-buffer saline) at pH 7.4 and at 37° C.is in the range of from 20 to 100 hours. In some embodiments, the invitro half-life for cabazitaxel release from the dendrimer in PBS at pH7.4 and at 37° C. is in the range of from 24 to 60 hours. In someembodiments, the in vitro half-life for cabazitaxel release from thedendrimer in PBS at pH 7.4 and at 37° C. is in the range of from 30 to60 hours. In some embodiments, the in vitro half-life for cabazitaxelrelease from the dendrimer in PBS at pH 7.4 and at 37° C. is in therange of from 30 to 50 hours.

Compositions

In some embodiments, the dendrimer is presented as a composition,preferably a pharmaceutical composition.

It will be appreciated that there may be some variation in the molecularcomposition between the dendrimers present in a given composition, as aresult of the nature of the synthetic process for producing thedendrimers. For example, as discussed above one or more synthetic stepsused to produce a dendrimer may not proceed fully to completion, whichmay result in the presence of dendrimers which do not all comprise thesame number of first terminal groups or second terminal groups, or whichcontain incomplete generations of building units.

Accordingly, there is provided a composition comprising a plurality ofdendrimers or pharmaceutically acceptable salts thereof, wherein thedendrimers are as defined herein,

the mean number of first terminal groups per dendrimer in thecomposition is in the range of from 24 to 32, and

the mean number of second terminal groups per dendrimer in thecomposition is in the range of from 24 to 32. In some embodiments, themean number of first terminal groups per dendrimer is in the range offrom 26 to 32, and wherein the mean number of second terminal groups perdendrimer is in the range of from 28 to 32. In some embodiments, themean number of first terminal groups per dendrimer is in the range offrom 28 to 32, or in the range of from 29 to 31. In some embodiments,the mean number of second terminal groups per dendrimer is in the rangeof from 29 to 31.

In some embodiments, at least 50%, at least 60%, at least 70%, at least80%, at least 90%, or at least 95% of the dendrimers contain at least 24first terminal groups. In some embodiments, at least 50%, at least 60%,at least 70%, at least 80%, at least 90%, or at least 95% of thedendrimers contain at least 26 first terminal groups. In someembodiments, at least 50%, at least 60%, at least 70%, at least 80%, atleast 90%, or at least 95% of the dendrimers contain at least 28 firstterminal groups.

In some embodiments, at least 50%, at least 60%, at least 70%, at least80%, at least 90%, or at least 95% of the dendrimers contain at least 28second terminal groups. In some embodiments, at least 50%, at least 60%,at least 70%, at least 80%, at least 90%, or at least 95% of thedendrimers contain at least 29 second terminal groups.

In some embodiments, at least 50%, at least 60%, at least 70%, at least80%, at least 90%, or at least 95% of the dendrimers contain at least 24first terminal groups and at least 28 second terminal groups. In someembodiments, at least 50%, at least 60%, at least 70%, at least 80%, atleast 90%, or at least 95% of the dendrimers contain at least 26 firstterminal groups and at least 29 second terminal groups.

In some embodiments, the composition comprising a plurality ofdendrimers or pharmaceutically acceptable salts thereof, comprisescabazitaxel residues in an amount of at least 20% w/w of the dendrimerspresent in the composition, at least 22% w/w, or at least 24% w/w. Insome embodiments, the composition comprising a plurality of dendrimersor pharmaceutically acceptable salts thereof, comprises cabazitaxelresidues in an amount of up to 30% w/w of the dendrimer, up to 28% w/wof the dendrimer or up to 26% w/w of the dendrimer. In some embodiments,the composition comprising a plurality of dendrimers or pharmaceuticallyacceptable salts thereof, comprises cab azitaxel residues in an amountin the range of from 20% w/w to 30% w/w, or from 23% w/w to 28% w/wr, orfrom 24% w/w to 26% w/w. The w/w % of the dendrimers which arecabazitaxel residues may be determined by any suitable means. In someembodiments, the w/w % of the dendrimers which are cabazitaxel residuemay be determined by ¹H NMR.

The present disclosure also provides pharmaceutical compositions, bothfor veterinary and for human medical use, which comprise the dendrimersof the present disclosure or a pharmaceutically acceptable salt thereof,with one or more pharmaceutically acceptable carriers, and optionallyany other therapeutic ingredients, stabilisers, or the like. Thecarrier(s) must be pharmaceutically acceptable in the sense of beingcompatible with the other ingredients of the formulation and not undulydeleterious to the recipient thereof. In some embodiments, thecomposition is a pharmaceutical composition, and wherein the compositioncomprises a pharmaceutically acceptable excipient. The compositions ofthe present disclosure may also include polymeric excipients/additivesor carriers, e.g., polyvinylpyrrolidones, derivatised celluloses such ashydroxymethylcellulose, hydroxyethylcellulose, andhydroxypropylmethylcellulose, Ficolls (a polymeric sugar),hydroxyethylstarch (HES), dextrates (e.g., cyclodextrins, such as2-hydroxypropyl-β-cyclodextrin and sulfobutylether-β-cyclodextrin),polyethylene glycols, and pectin. The compositions may further includediluents, buffers, citrate, trehalose, binders, disintegrants,thickeners, lubricants, preservatives (including antioxidants),inorganic salts (e.g., sodium chloride), antimicrobial agents (e.g.,benzalkonium chloride), sweeteners, antistatic agents, sorbitan esters,lipids (e.g., phospholipids such as lecithin and otherphosphatidylcholines, phosphatidylethanolamines, fatty acids and fattyesters, steroids (e.g., cholesterol)), and chelating agents (e.g., EDTA,zinc and other such suitable cations). Other pharmaceutical excipientsand/or additives suitable for use in the compositions according to thepresent disclosure are listed in “Remington: The Science & Practice ofPharmacy”, 19.sup.th ed., Williams & Williams, (1995), and in the“Physician's Desk Reference”, 52.sup.nd ed., Medical Economics,Montvale, N.J. (1998), and in “Handbook of Pharmaceutical Excipients”,Third Ed., Ed. A. H. Kibbe, Pharmaceutical Press, 2000.

In some embodiments, the composition is a solid composition which issuitable for reconstitution with a diluent. For example, the compositionmay be in the form of a powder or granules. Such compositions may beadvantageous for transport and/or storage of the dendrimer prior toadministration, e.g. assisting in providing for stability of thedendrimer.

In some embodiments, a stable composition is one in which the rate ofcabazitaxel release from the dendrimer is less than 1%, less than 0.5%,less than 0.2%, or less than 0.1% of total cabazitaxel over a 4 hoursperiod at room temperature, e.g. 25° C.).

Excipients used with such solid compositions may include, for example, abuffer or other pH-controlling agent. The pH controlling agent may forexample be useful in preserving and/or maintaining chemical stability ofthe dendrimer, either in the solid composition itself, or in asubsequent reconstituted composition, if the solid composition isadmixed with a diluent. In some embodiments, an acid is used in a solidcomposition which, following reconstitution with diluent, can provide apH of at less than 6, or which can provide a pH in the range of lessthan 5, or which can provide a pH in the range of from 3.5 to 5.5, orwhich can provide a pH in the range of from 4 to 5, or which can providea pH of about 4.5. In some embodiments, following reconstitution with adiluent, the reconstituted composition has a pH in the range of lessthan 5, in the range of from 3.5 to 5.5, in the range of from 4 to 5, orof about 4.5. In some embodiments, an acid is used which has an acidicgroup with a pKa in the range of from 4 to 5. In some embodiments, anacid such as citric acid is included in the composition.

In some embodiments, the solid composition comprises a bulking agent,for example a non-reducing sugar. In some embodiments, the sugar is adisaccharide. In some embodiments, the sugar is trehalose, mannitol,sorbitol or lactose.

In some embodiments, the solid composition comprises a sugar and anacid, and the composition is for reconstitution with a diluent. In someembodiments, the composition comprises trehalose and citric acid.

In some embodiments, the composition comprises dendrimer and a sugar(preferably trehalose) at a weight ratio in the range of from 1:1 to1:3, or at a weight ratio of about 1:2. In some embodiments, thecomposition comprises dendrimer and acid (preferably citric acid) in aweight ratio in the range of from 1:0.5 to 1:2, or about 1:1, or 1:0.96.In some embodiments, the weight ratio of dendrimer:sugar:acid is about100:200:96. In some embodiments, the weight ratio ofdendrimer:sugar:acid in the composition is about 100:200:96, and thecomposition comprises cabazitaxel residues in an amount of from 23% w/wto 28% w/w of the dendrimer.

In some embodiments, the composition is produced by lyophilisation, i.e.it is a lyophilisate. In some embodiments the composition is a solidlyophilisate comprising the dendrimer or a pharmaceutically acceptablesalt thereof, a sugar and an acid. In some embodiments, the compositionis a solid lyophilisate comprising the dendrimer or a pharmaceuticallyacceptable salt thereof, trehalose and citric acid.

In some embodiments, the composition is a liquid composition, e.g. areconstituted composition, which is suitable for administration by, forexample, injection or infusion. For example, the composition may be areconstituted composition produced by admixing of a solid composition asdiscussed above with a diluent such as saline or WFI (water forinjection).

In some embodiments, the liquid composition is a reconstitutedcomposition which is sufficiently stable at ambient conditions (e.g. atabout 25° C.) for use up to 2 hours, up to 4 hours, up to 6 hours, up to12 hours, or up to 24 hours, or up to 48 hours, or up to 1 weekfollowing reconstitution. In some embodiments, the liquid composition isa reconstituted composition which is sufficiently stable onrefrigeration (e.g. at about 4° C.) for use up to 2 hours, up to 4hours, up to 6 hours, up to 12 hours, or up to 24 hours, or up to 48hours, or up to 1 week following reconstitution. In some embodiments,the liquid composition is a reconstituted composition which issufficiently stable when protected from light for use up to 2 hours, upto 4 hours, up to 6 hours, up to 12 hours, or up to 24 hours, or up to48 hours, or up to 1 week following reconstitution.

It has been found that, following reconstitution but before transferringinto an infusion bag (saline), the data show that a reconstitutedsolution according to the invention is stable (less than 0.1%cabazitaxel release) for at least 4 hours at room temperature (25±5°C.).

In some embodiments, the liquid composition is one in which the rate ofcabazitaxel release from the dendrimer when present in the compositionis less than 1%, less than 0.5%, less than 0.2%, or less than 0.1% oftotal cabazitaxel over a 4 hours period at room temperature, e.g. 25°C.).

In some embodiments, the liquid composition is a reconstitutedcomposition present in an infusion bag. In some embodiments, the liquidcomposition is a reconstituted composition present in a syringe.

It will be appreciated that the compositions described above, can beutilised with drug-dendrimer conjugates other than those described inthe first aspect, for example with other drug-dendrimer conjugates inwhich the pharmaceutically active agent is linked through a hydroxylgroup to the dendrimer via a diglycolyl linker.

Accordingly, also provided herein is a pharmaceutical compositioncomprising a) a dendrimer comprising a core unit, building units, aplurality of first terminal groups (T1) each comprising a residue of apharmaceutically active agent comprising a hydroxyl group which iscovalently attached to a diglycolyl linker group; and a plurality ofsecond terminal groups (T2) each comprising a pharmacokinetic modifier;wherein the first and second terminal groups are covalently attached toouter building units; and b) an acid. In some embodiments, thepharmaceutically active agent is an oncology agent, for example a taxanesuch as docetaxel or cabazitaxel. In some embodiments, thepharmacokinetic modifier comprises a PEG or PEOX group. In someembodiments, the pharmacokinetic modifier comprises a PEG group. In someembodiments the core is a BHALys group. In some embodiments the buildingunits are lysine residues or an analogue thereof. In some embodiments,the dendrimer is a five generation building unit dendrimer. In someembodiments, the acid is citric acid. In some embodiments, thecomposition comprises c) a sugar, for example a disaccharide, e.g.trehalose. In some embodiments, the composition is a solid composition.In some embodiments, the composition is produced by lyophilisation, i.e.it is a solid lyophilisate. In some embodiments, the composition is forreconstitution with a diluent. In some embodiments, the composition is aliquid composition, e.g. a reconstituted composition, which is suitablefor administration by, for example, injection or infusion. For example,the composition may be a reconstituted composition produced by admixingof a solid composition as discussed above with a diluent such as salineor WFI (water for injection). The dendrimers of the present disclosuremay be presented in compositions including those suitable for inhalationto the lung, by aerosol, or parenteral (including intraperitoneal,intravenous, subcutaneous, or intramuscular injection) administration.The compositions may conveniently be presented in unit dosage form andmay be prepared by any of the methods well known in the art of pharmacy.All methods include the step of bringing the dendrimer into associationwith a carrier that constitutes one or more accessory ingredients. Ingeneral, the compositions are prepared by bringing the dendrimer intoassociation with a liquid carrier to form a solution or a suspension, oralternatively, bring the dendrimer into association with compositioncomponents suitable for forming a solid, optionally a particulateproduct, and then, if warranted, shaping the product into a desireddelivery form. Solid compositions of the present disclosure, whenparticulate, will typically comprise particles with sizes ranging fromabout 1 nanometer to about 500 microns. In general, for solidcompositions intended for intravenous administration, particles willtypically range from about 1 nm to about 10 microns in diameter. Thecomposition may contain dendrimer of the present disclosure that arenanoparticulate having a particulate diameter of below 1000 nm, forexample, between 5 and 1000 nm, especially 5 and 500 nm, more especially5 to 400 nm, such as 5 to 50 nm and especially between 5 and 20 nm. Inone example, the composition contains dendrimers with a mean size ofbetween 5 and 20 nm. In some embodiments, the dendrimer is polydispersedin the composition, with PDI of between 1.01 and 1.8, especially between1.01 and 1.5, and more especially between 1.01 and 1.2. In one example,the dendrimer is monodispersed in the composition.

In some preferred embodiments, the composition is for patenteraldelivery. For example, in one embodiment, the composition may be asterile, lyophilized composition that is suitable for reconstitution inan aqueous vehicle prior to injection.

In one embodiment, a composition suitable for parenteral administrationconveniently comprises a sterile aqueous preparation of the dendrimer,which may for example be prepared so as to be isotonic with the blood ofthe recipient.

Pharmaceutical compositions are also provided which are suitable foradministration as an aerosol, by inhalation. These compositions comprisea solution or suspension of the desired dendrimer or a salt thereof. Thedesired composition may be placed in a small chamber and nebulized.Nebulization may be accomplished by compressed air or by ultrasonicenergy to form a plurality of liquid droplets or solid particlescomprising the dendrimers or salts thereof.

In some embodiments, the composition may be formulated foradministration as an infusion. In some embodiments, the composition maybe formulated for administration as a bolus dose. In some embodiments,the composition is formulated for administration as an infusion over atime period of up to 30 minutes, or is formulated for administration asa bolus over a time period of up to 5 minutes.

As discussed below, the dendrimers of the present disclosure may forexample be administered in combination with one or more additionalpharmaceutically active agents. Thus, in some embodiments, thecomposition comprises a dendrimer as defined herein, or apharmaceutically acceptable salt thereof, one or more pharmaceuticallyacceptable carriers, and one or more additional pharmaceutically activeagents, e.g. an additional oncology agent, a small molecule cytotoxic, acheckpoint inhibitor, an antibody therapy. In some embodiments, thecomposition comprises a dendrimer as defined herein, or apharmaceutically acceptable salt thereof, and an additional oncologyagent, such as gemcitabine. Not only can the dendrimers of the presentdisclosure be administered with other chemotherapy drugs but may also beadministered in combination with other medications such ascorticosteroids, anti-histamines, analgesics and drugs that aid inrecovery or protect from hematotoxicity, for example, cytokines.

In some embodiments, the composition is for parenteral infusion as partof a chemotherapy regimen. In these embodiments, the composition may forexample be substantially free or entirely free of solubilisationexcipients, especially solubilisation excipients such as apolyethoxylated castor oil (e.g. such as that sold under the trade nameCremophor® or Kolliphor®), or a polyethoxylated sorbitan monooleate(such as that sold under the trade name polysorbate 80®). Solubilisationexcipients are additives which aid dissolution of the dendrimer in thesolvent or solvents. In one embodiment the composition is substantiallyfree or entirely free of a polyethoxylated castor oil (e.g. such as thatsold under the trade name Cremophor® or Kolliphor®) and apolyethoxylated sorbitan monooleate (e.g. such as polysorbate 80®). Inone embodiment, the composition is substantially or entirely free of asolubilisation excipient. By avoiding the use of solubilisationexcipients, the composition of dendrimer is less likely to cause sideeffects such as acute or delayed hypersensitivity includinglife-threatening anaphylaxis and/or severe fluid retention, and/orremove the need for steroid pre-treatment.

Methods of Use

The dendrimers of the present disclosure may be used to treat or preventany disease, disorder or symptom that the unmodified pharmaceuticallyactive agent can be used to treat or prevent. Accordingly, there is alsoprovided a dendrimer or pharmaceutical composition as described hereinfor use in therapy.

In some embodiments, there is provided a method of treating a cancercomprising administering to a subject in need thereof a therapeuticallyeffective amount of a dendrimer comprising:

i) a core unit (C); and

ii) building units (BU), each building unit being a lysine residue or ananalogue thereof;

wherein the core unit is covalently attached to two building units viaamide linkages, each amide linkage being formed between a nitrogen atompresent in the core unit and the carbon atom of an acyl group present ina building unit;

the dendrimer being a five generation building unit dendrimer;

wherein building units of different generations are covalently attachedto one another via amide linkages formed between a nitrogen atom presentin one building unit and the carbon atom of an acyl group present inanother building unit;

iii) a plurality of first terminal groups (T1) comprising a cabazitaxelresidue covalently attached to a diglycolyl linker group; and

iv) a plurality of second terminal groups (T2) comprising a PEG or PEOXgroup;

wherein at least one third of the nitrogen atoms present in outerbuilding units are each covalently attached to a first terminal group;and

at least one third of the nitrogen atoms present in outer building unitsare each covalently attached to a second terminal group;

and wherein the therapeutically effective amount of dendrimeradministered to the subject provides about 20 mg/m² of cabazitaxel.

In some embodiments, the dendrimer is used in a method of treating orpreventing cancer, for example for suppressing the growth of a tumour.In some embodiments, the dendrimer is for use in the treatment ofcancer. There is also provided a method of treating cancer comprisingadministering to a subject in need thereof a therapeutically effectiveamount of the dendrimer. There is also provided use of a dendrimer asdefined herein, or of a composition as defined herein, in themanufacture of a medicament for the treatment of cancer.

In some embodiments, the cancer is a solid tumour. The cancer may be aprimary or metastatic tumour. In some embodiments the cancer is aprimary tumour. In some embodiments the cancer is a metastatic tumour.

In some embodiments, the cancer, is selected from the group consistingof breast cancer, ovarian cancer (e.g. recurrent ovarian cancer),pancreatic cancer, testicular cancer (e.g. cis-platin-resistant germcell cancer), prostate cancer (e.g. bone metastatic prostate cancer,prostatic neoplasms, hormone-refractory prostate cancer, castrationresistant prostate cancer, advanced prostate cancer), dedifferentiatedliposarcoma, urothelial carcinoma of the urinary bladder (e.g.urothelium transitional cell carcinoma (TCCU)), adrenocorticalcarcinoma, brain cancer (e.g. recurrent malignant glioma), AML (acutemyeloid leukemia) and CLL (chronic lymphocytic leukemia). In someembodiments, the cancer is prostate cancer, pancreatic cancer, ovariancancer or breast cancer. In some embodiments the cancer is prostatecancer, for example hormone-refractory prostate cancer, or for examplemetastatic castration-resistant prostate cancer (mCRPC). In someembodiments the cancer is breast cancer. In some embodiments, the canceris pancreatic cancer. In some embodiments, the cancer is ovarian cancer.In some embodiments, the cancer is a tumour of the sweat glands, forexample a digital papillary adenocarcinoma.

In some embodiments, the cancer is selected from the group consisting ofpancreatic cancer, prostate cancer, breast cancer, ovarian cancer,gastro-oesophageal cancer, thymic cancer, hepatobiliary cancer, head andneck squamous cell carcinomas, non-small cell lung carcinoma, cervicalcancer, and digital papillary adenocarcinoma. In one example, the canceris pancreatic cancer. In one example, the ovarian cancer is granulosecell cancer. In one example, the gastro-oesophageal cancer isgastro-oesophageal junction adenocarcinoma. In one example, thegastro-oesophageal cancer is an oesophageal squamous cell carcinoma(SCC). In one example, the hepatobiliary cancer is a cholangiocarcinoma.In some embodiments, the prostate cancer is selected from the groupconsisting of bone metastatic prostate cancer, prostatic neoplasms,hormone-refractory prostate cancer, metastatic castration-resistantprostate cancer, and advanced prostate cancer. In one example, theprostate cancer is metastatic castration-resistant prostate cancer.

In some embodiments, the dendrimer which is used in therapy (e.g. incancer therapy) has a core which is:

In some embodiments, the dendrimer which is used in therapy (e.g. incancer therapy) has building units which are each:

wherein the acyl group of each building unit provides a covalentattachment point for attachment to the core or to a previous generationbuilding unit; and wherein each nitrogen atom provides a covalentattachment point for covalent attachment to a subsequent generationbuilding unit, a first terminal group or a second terminal group.

In some embodiments, the dendrimer which is used in therapy (e.g. incancer therapy) has first terminal groups (T1) which are each:

In some embodiments, the dendrimer used in therapy (e.g. in cancertherapy) has second terminal groups which are each

and wherein the PEG group is a methoxy-terminated PEG having a meanmolecular weight in the range of from about 1750 to 2500 Daltons.

In some embodiments, the dendrimer used in therapy (e.g. in cancertherapy) has from 26 to 32 first terminal groups, and from 28 to 32second terminal groups.

In some embodiments, the dendrimer used in therapy (e.g. in cancertherapy) is

in which T1′ represents a first terminal group which is

or T1′ represents H, wherein less than 5 of T1′ are H; andT2′ represents a second terminal group which is

wherein the PEG group is a methoxy-terminated PEG having a molecularweight in the range of from about 1750 to 2500 Daltons, or T2′represents H, and wherein less than 5 of T2′ are H.

Drugs are often co-administered with other drugs in combination therapy,especially during chemotherapy. Accordingly, in some embodiments thedendrimer is administered in combination with one or more furthertherapeutic/pharmaceutically active agents, for example one or morefurther anti-cancer agents. The dendrimer and the one or more furthertherapeutic/pharmaceutically active agents may be administeredsimultaneously, subsequently or separately. For example, they may beadministered as part of the same composition, or by administration ofseparate compositions. The one or more further pharmaceutically activeagents may for example be anti-cancer agents for therapy of prostatecancer or breast cancer, or e.g. for therapy of pancreatic cancer orovarian cancer. Examples of further pharmaceutically active agentsinclude chemotherapeutic and cytotoxic agents, immune-oncology agents(such as checkpoint inhibitors), and antibody therapies. Examples offurther pharmaceutically active agents include paclitaxel, docetaxel,abraxane, clarithromycin, vinflunine, bavituximab, tocotrienol,gemcitabine, capecitabine, carboplatin, oxaliplatin, niraparib, folinicacid, 5-fluorouracil, irinotecan, tamsulosin, ADT, G-CSF, an LHRHantagonist, bicalutamide, enzlutamide, clarithromycin, vinflunine,bacituximab and bevacizumab.

The current label for Jevtana® (free cabazitaxel) states that it isadministered as a one-hour intravenous infusion in combination with oralprednisone 10 mg administered daily throughout Jevtana® treatment. Inaddition, premedication is recommended at least 30 minutes prior to eachdose of Jevtana® with the following intravenous medications to reducethe risk and/or severity of hypersensitivity (i) antihistamine(dexchlorpheniramine 5 mg, or diphenhydramine 25 mg or equivalentantihistamine), (ii) corticosteroid (dexamethasone 8 mg or equivalentsteroid), and (iii) H2 antagonist (ranitidine 50 mg or equivalent H2antagonist).

In some embodiments, the dendrimer or composition comprising thedendrimer is not administered in combination with a steroid or othermedicament used in the delivery of Jevtana®. In some embodiments, thedendrimer or composition comprising the dendrimer is not administered aspart of a regime requiring premedication. In some embodiments, thedendrimer or composition comprising the dendrimer is not administered incombination with a medication which reduces the risk and/or severity ofhypersensitivity, is not administered as part of a regime requiringpremedication with a medication which reduces the risk and/or severityof hypersensitivity, and is not administered as part of a regimerequiring ongoing treatment with a medication which reduces the riskand/or severity of hypersensitivity. In some embodiments, the dendrimeror composition comprising the dendrimer is not administered incombination with an antihistamine, corticosteroid or H2 antagonist, andis not administered as part of a regime requiring premedication with anantihistamine, corticosteroid or H2 antagonist, and is not administeredas part of a regime requiring ongoing treatment with an antihistamine,corticosteroid (e.g. prednisone, prednisolone), immune suppressant, orH2 antagonist.

It will be appreciated that a therapeutically effective amount refers toa dendrimer being administered in an amount sufficient to alleviate orprevent to some extent one or more of the symptoms of the disorder orcondition being treated. A therapeutically effective amount of dendrimermay be referred to based on, for example, the amount of dendrimeradministered. Alternatively, it may be determined based on the amount ofactive agent (cabazitaxel) which the dendrimer is theoretically capableof delivering, e.g. based on the loading of cabazitaxel on thedendrimer.

In some embodiments, the amount of dendrimer administered is sufficientto deliver between 5 and 100 mg of active agent/m², between 10 and 100mg of active agent/m², between 5 and 50 mg of active agent/m², between 5and 40 mg of active agent/m², between 5 and 30 mg of active agent/m²,between 5 and 25 mg of active agent/m², between 5 and 20 mg of activeagent/m², between 10 and 50 mg of active agent/m², between 20 and 40 mgof active agent/m², between 15 and 35 mg of active agent/m², between 10and 20 mg/m², between 20 and 30 mg/m², between 20 and 50 mg/m², between25 and 50 mg/m², between 30 and 40 mg/m², between 15 and 20 mg/m²,between 10 and 15 mg/m², between 5 and 10 mg/m², between 25 and 35 mg ofactive agent/m², between 25 and 30 mg of active agent/m², between 50 and100 mg of active agent/m², between 50 and 75 mg of active agent/m², orbetween 75 and 100 mg of active agent/m². Cabazitaxel is indicated foruse at 20-25 mg/m² and similar or slightly higher doses of active agenthave been demonstrated to be effective for the dendrimer in thecomparative mouse studies below. A dose of active agent of 10 mg/kg in amouse should be approximately equivalent to a human dose of 30 mg/m²(FDA guidance 2005). (To convert human mg/kg dose to mg/m², the figuremay be multiplied by 37, FDA guidance 2005).

In some embodiments, the amount of dendrimer administered delivers anamount of cabazitaxel to a patient which is in the range of from 0.5 to3 times the amount of cabazitaxel delivered upon administration of 20-25mg/m² free cabazitaxel. In some embodiments, the amount of dendrimeradministered delivers an amount of cabazitaxel to a patient which is inthe range of from 1 to 2 times the amount of cabazitaxel delivered uponadministration of 20-25 mg/m² free cabazitaxel. In some embodiments, theamount of dendrimer administered delivers an amount of cabazitaxel to apatient which is in the range of from 0.5 to less than 1 times theamount of cabazitaxel delivered upon administration of 20-25 mg/m² freecabazitaxel. In some embodiments, the amount of dendrimer administereddelivers an amount of cabazitaxel to a patient which is in the range offrom 0.5 to 1.5 times the amount of cabazitaxel delivered uponadministration of 20-25 mg/m² free cabazitaxel. In some embodiments, theamount of dendrimer administered delivers an amount of cabazitaxel to apatient which is in the range of from 0.8 to 1.2 times the amount ofcabazitaxel delivered upon administration of 20-25 mg/m² freecabazitaxel. In some embodiments, the amount of dendrimer administereddelivers substantially an equivalent amount of cabazitaxel to thatdelivered on administration of an authorised dosage of free cabazitaxel(e.g. Jevtana®). For example, as discussed above, recommended dosagelevels for cabazitaxel are 20-25 mg/m². In some embodiments, the amountof dendrimer administered is capable of delivering an amount ofcabazitaxel to a patient substantially equivalent to administration of20-25 mg/m² free cabazitaxel. The amount of dendrimer administered mayfor example be determined with reference to the amount of cabazitaxelwhich the dendrimer is capable of delivering (i.e. cabazitaxel loading).In some embodiments, the therapeutically effective amount of thedendrimer administered to the subject provides about 20 mg/m² ofcabazitaxel.

In some embodiments, a therapeutically effective amount of the dendrimeris administered to a subject in need thereof at a predeterminedfrequency. In some embodiments, the dendrimer is administered to asubject in need thereof according to a dosage regimen in which thedendrimer is administered once per one to four weeks. In someembodiments, the dendrimer is administered to a subject in need thereofaccording to a dosage regimen in which the dendrimer is administeredonce per three to four weeks.

In some embodiments, the dendrimer or pharmaceutical composition isadministered as a fast infusion or as a bolus. In some embodiments, theinfusion time is over a period of less than 2 hours, less than 1 hour,less than 30 minutes or less than 20 minutes, for example it may beadministered over a period of about 20 minutes, 15 minutes or 10minutes. In one example, the dendrimer or pharmaceutical composition isadministered as an infusion over a time period of about 60 minutes. Insome embodiments, the administration may be as a bolus, for example itmay be administered over a time period suitable for a bolus injection,e.g. a time period of up to about 5 minutes, e.g. in the range of from 5seconds to 5 minutes. In one example, the dendrimer or pharmaceuticalcomposition is administered as a bolus over a time period of up to 5minutes.

It has been surprisingly found that a dendrimer of the presentdisclosure has increased efficacy in comparison to the directadministration of the free drug.

An equivalent dose of free cabazitaxel is the equivalent amount of freecabazitaxel to the amount of cabazitaxel contained (loaded) in the doseof dendrimer to be administered.

As used herein, the term “free” refers to a drug, i.e., cabazitaxel,which has not been previously conjugated to a dendrimer. For example,the direct administration of free cabazitaxel refers to the directadministration of cabazitaxel molecules that are not administered asbeing conjugated to a dendrimer. An example of such a therapy isJevtana®. As used herein, the terms “unconjugated” and “released” referto a drug, i.e. cabazitaxel, which has dissociated or been cleaved froma dendrimer. Accordingly, the administration of a dendrimer, asdescribed herein, is said to “provide” an amount of free/releasedcabazitaxel. In one example, the administration of a dendrimer, asdescribed herein, provides about 20 mg/m² of free/released cabazitaxel(i.e., an amount of 20 mg/m² of free cabazitaxel once dissociated orcleaved from the dendrimer). This dissociation or cleaving may occur invivo following administration of the drug-dendrimer conjugate.

In some embodiments, administration of the dendrimer provides enhancedclinical efficacy in comparison to administration of an equivalent doseof free cabazitaxel.

In some embodiments, administration of a course of the dendrimerprovides enhanced clinical efficacy in comparison to three-weeklyadministration of 20 or 25 mg/m² cabazitaxel.

In some embodiments, administration of a course of the dendrimerprovides enhanced clinical efficacy in comparison to three-weeklyadministration of 20 mg/m² cabazitaxel.

In some embodiments, administration of the dendrimer provides for:

alleviating or eliminating symptoms associated with cancer,

reducing cancerous tissue size,

increasing progression-free survival, and/or

slowing or preventing metastasis,

in at least 10%, at least 20%, at least 30%, at least 40% or at least50% of the patient population.

Oncology drugs often have significant side effects that are due tooff-target toxicity such as hematologic toxicity, neurological toxicity,cardiotoxicity, hepatotoxicity, nephrotoxicity, ototoxicity andencephalotoxicity. For example, taxanes such as cabazitaxel may causethe following adverse effects: infections, neutropenia, anaemia, febrileneutropenia, hypersensitivity, thrombocytopenia, myelotoxicity,myelosuppression, neuropathy, dysgeusia, dyspnoea, constipation,anorexia, nail disorders, fluid retention, asthenia, pain, nausea,diarrhoea, vomiting, fatigue, non-specific neuro cognitive problems,vertigo, encephalopathy, mucositis, alopecia, skin reactions andmyalgia.

In particular, the most common Grade 3-4 adverse effects in patients whoreceive Jevtana (cabazitaxel) include primarily blood and lymphaticdisorders. Other grade 3-4 adverse effects include cardiac disorders,gastrointestinal disorders, metabolism and nutrition disorders, nervoussystem disorders, musculoskeletal and connective tissue disorders,respiratory and thoracic and mediastinal disorders, skin disorders,vascular disorders, and other general disorders. In one example,administration of the dendrimer provides a reduction in a grade 3 orgrade 4 side effect. In one example, administration of the dendrimerprovides a reduction in a grade 3 or grade 4 blood or lymphaticdisorder. In one example, administration of the dendrimer provides areduction in a grade 3 or grade 4 blood or lymphatic disorder selectedfrom the group consisting of neutropenia, febrile neutropenia, anemia,leukopenia, and thrombocytopenia. In one example, administration of thedendrimer provides a reduction in a grade 3 or grade 4 cardiac disorder,wherein the cardiac disorder is arrhythmia. In one example,administration of the dendrimer provides a reduction in a grade 3 orgrade 4 gastrointestinal disorder selected from the group consisting ofdiarrhea, nausea, vomiting, constipation, abdominal pain, and dyspepsia.In one example, administration of the dendrimer provides a reduction ina grade 3 or grade 4 skin disorder, wherein the skin disorder isalopecia. In one example, administration of the dendrimer provides areduction in a grade 3 or grade 4 disorder selected from the groupconsisting of fatigue, asthenia, pyrexia, peripheral edema, mucosalinflammation, pain, and haematuria.

In one example, administration of the dendrimer provides a reduction ina side effect selected from the group consisting of alopecia,leukopenia, asthenia, haematuria, neutropenia, lymphopenia, anemia, andthrombocytopenia, in comparison to administration of 20 mg/m² of freecabazitaxel.

In one example, administration of the dendrimer provides a reduction inneutropenia in comparison to administration of 20 mg/m² of freecabazitaxel. In one example, administration of the dendrimer provides areduction in alopecia in comparison to administration of 20 mg/m² offree cabazitaxel. In one example, administration of the dendrimerprovides a reduction in leukopenia in comparison to administration of 20mg/m² of free cabazitaxel. In one example, administration of thedendrimer provides a reduction in asthenia in comparison toadministration of 20 mg/m² of free cabazitaxel. In one example,administration of the dendrimer provides a reduction in haematuria incomparison to administration of 20 mg/m² of free cabazitaxel. In oneexample, administration of the dendrimer provides a reduction inlymphopenia in comparison to administration of 20 mg/m² of freecabazitaxel. In one example, administration of the dendrimer provides areduction in anemia in comparison to administration of 20 mg/m² of freecabazitaxel. In one example, administration of the dendrimer provides areduction in thrombocytopenia in comparison to administration of 20mg/m² of free cabazitaxel.

In some embodiments, administration of the dendrimer provides reducedtoxicity in comparison to administration of an equivalent dose of freecabazitaxel. The toxicity of a drug refers to the degree to which damageis caused to the organism, and is measured by its effect off target. Inoncology, one such measurement of toxicity in animal models is weightloss, which determines the maximum tolerated dose (MTD). In humans,toxicity is commonly determined by specified adverse events (AE), whichtypically include the dose limiting toxicity. It will be appreciatedthat usually in oncology, there is a narrow therapeutic window andoff-target toxicities are considered a normal side effect of killingtumour cells.

In some embodiments, administration of the dendrimer provides reducedtoxicity in comparison to administration of an equivalent dose of freecabazitaxel when used in a method of treatment of cancer, for example,in the treatment of cancer, such as breast cancer, ovarian cancer,pancreatic cancer or prostate cancer, e.g. hormone-refractory prostatecancer, metastatic castration-resistant prostate cancer (mCRPC).

In some embodiments, administration of the dendrimer provides reducedtoxicity in comparison to three-weekly administration of 20 or 25 mg/m²cabazitaxel. In some embodiments, administration of the dendrimerprovides reduced toxicity in comparison to three-weekly administrationof 20 mg/m² cabazitaxel.

In some embodiments, administration of the dendrimer provides reducedtoxicity in comparison to three-weekly administration of 20 or 25 mg/m²cabazitaxel, when used in a method of treatment of cancer, for example,in the treatment of cancer, such as breast cancer, ovarian cancer,pancreatic cancer or prostate cancer, e.g. hormone-refractory prostatecancer, metastatic castration-resistant prostate cancer (mCRPC). In someembodiments, administration of the dendrimer provides reduced toxicityin comparison to three-weekly administration of 20 mg/m² cabazitaxel,when used in a method of treatment of cancer, for example, in thetreatment of cancer, such as breast cancer, ovarian cancer, pancreaticcancer or prostate cancer, e.g. hormone-refractory prostate cancer,metastatic castration-resistant prostate cancer (mCRPC).

In some embodiments, administration of a course of the dendrimerprovides reduced toxicity in comparison to three-weekly administrationof 20 or 25 mg/m² cabazitaxel. In some embodiments, administration of acourse of the dendrimer provides reduced toxicity in comparison tothree-weekly administration of 20 mg/m² cabazitaxel.

In some embodiments, administration of a course of the dendrimerprovides reduced toxicity in at least 10%, at least 20%, at least 30%,at least 40% or at least 50% of the patient population.

Toxicology studies carried out with a dendrimer of the presentdisclosure indicate that the dendrimer is likely to induce lessneutropenia, and therefore be less toxic in the clinic, compared withthe administration of an equivalent dose of free cabazitaxel.

Accordingly, in some embodiments, administration of the dendrimerprovides reduced bone marrow toxicity, for example in the form ofreduced neutropenia, lymphopenia, anemia and/or thrombocytopenia, incomparison to administration of an equivalent dose of free cabazitaxel.In some embodiments, administration of the dendrimer provides reducedneutropenia in comparison to administration of an equivalent dose offree cabazitaxel.

In some embodiments, administration of a course of the dendrimerprovides reduced neutropenia, lymphopenia, anemia, and/orthrombocytopenia in comparison to three-weekly administration of 20 or25 mg/m² cabazitaxel. In some embodiments, administration of a course ofthe dendrimer provides reduced neutropenia, lymphopenia, anemia, and/orthrombocytopenia in comparison to three-weekly administration of 20mg/m² cabazitaxel.

In some embodiments, administration of the dendrimer provides reducedbone marrow toxicity, for example in the form of reduced neutropenia,lymphopenia, anemia and/or thrombocytopenia, in comparison toadministration of an equivalent dose of free cabazitaxel, when used in amethod of treatment of cancer. In some embodiments, administration ofthe dendrimer provides reduced neutropenia in comparison toadministration of an equivalent dose of free cabazitaxel, when used in amethod of treatment of cancer, for example, in the treatment of cancer,such as breast cancer, ovarian cancer, pancreatic cancer or prostatecancer, e.g. hormone-refractory prostate cancer, metastaticcastration-resistant prostate cancer (mCRPC). In some embodiments,administration of a course of the dendrimer provides reduced neutropeniain comparison to three-weekly administration of 20 or 25 mg/m²cabazitaxel, when used in a method of treatment of cancer, for example,in the treatment of cancer, such as breast cancer, ovarian cancer,pancreatic cancer or prostate cancer, e.g. hormone-refractory prostatecancer, metastatic castration-resistant prostate cancer (mCRPC). In someembodiments, administration of a course of the dendrimer providesreduced neutropenia in comparison to three-weekly administration of 20mg/m² cabazitaxel, when used in a method of treatment of cancer, forexample, in the treatment of cancer, such as breast cancer, ovariancancer, pancreatic cancer or prostate cancer, e.g. hormone-refractoryprostate cancer, metastatic castration-resistant prostate cancer(mCRPC).

In some embodiments, the dendrimer provides a reduction in toxicity asmeasured by the number of patients having specified AE (e.g. infections(cystitis, upper respiratory tract, herpes zoster, candidiasis, sepsis,influenza, UTI) fever, neutropenia, anaemia, febrile neutropenia,thrombocytopenia, leukopenia, haematuria, myelotoxicity,myelosuppression, neuropathy, hypersensitivity, dysgeusia,gastrointestinal toxicity, dyspnoea, cough, abdominal pain,constipation, anorexia, nail disorders, fluid retention, asthenia, pain,nausea, diarrhoea, vomiting, fatigue, non-specific neuro cognitiveproblems, headache, vertigo, back pain, arthralgia, encephalopathy,mucositis, alopecia, skin reactions and myalgia), by at least 10%, atleast 20%, at least 30%, at least 40%, at least 50%, at least 60%, atleast 70%, at least 80%, or at least 90%, in comparison to the directadministration of an equivalent dose of the free pharmaceutically activeagent. In one example, administration of the dendrimer provides lessthan 95%, less than 90%, less than 80%, less than 70%, less than 60%,less than 50%, less than 40%, less than 30%, less than 20%, or less than10% toxicity in comparison to the direct administration of an equivalentdose of free cabazitaxel.

Prior to administration of the dendrimers of the present disclosure, apatient may have received prior treatment. Such pre-treatments, orprophylactic treatments, include primary granulocyte colony stimulatingfactor (G-CSF) prophylaxis. G-CSF may be used for the haematologicalsupport of cancer patients receiving chemotherapy, but is not in itselfa chemotherapeutic. It has been surprisingly found that administrationof the dendrimers of the present disclosure are effective in thetreatment of cancer in the absence of pre-treatment with primarygranulocyte colony stimulating factor (G-CSF) prophylaxis.

Accordingly, in one embodiment, there is provided a method of treating acancer comprising administering to a subject in need thereof atherapeutically effective amount of a dendrimer, as described herein,wherein the therapeutically effective amount of dendrimer administeredto the subject provides about 20 mg/m² of cabazitaxel, and wherein thesubject has not received primary granulocyte colony stimulating factor(G-CSF) prophylaxis.

Another pre-treatment, or prophylactic treatment, may include theadministration of one or more relevant steroids as prophylaxis.Administration of the dendrimers of the present disclosure may beeffective in the treatment of cancer in the absence of pre-treatmentwith one or more steroids as prophylaxis. In one example, there isprovided a method of treating a cancer comprising administering to asubject in need thereof a therapeutically effective amount of adendrimer, as described herein, wherein the therapeutically effectiveamount of dendrimer administered to the subject provides about 20 mg/m²of cabazitaxel, and wherein the subject has not received steroidprophylaxis.

In some embodiments, the dendrimers of the present disclosure areadministered to a subject wherein the age of the subject is at leastabout 65, at least about 70, at least about 75, at least about 80, atleast about 85, or at least about 90 years of age. In one example, thedendrimers of the present disclosure are administered to a subjectwherein the age of the subject is at least about 65 years of age.

In one example, there is provided a method of treating a cancercomprising administering to a subject in need thereof a therapeuticallyeffective amount of a dendrimer, as described herein, wherein thesubject is at least about 65 years of age. In one example, there isprovided a method of treating a cancer comprising administering to asubject in need thereof a therapeutically effective amount of adendrimer, as described herein, wherein the cancer is metastaticcastration-resistant prostate cancer and the subject has not receivedprimary granulocyte colony stimulating factor (G-CSF) prophylaxis. Inone example, there is provided a method of treating a cancer comprisingadministering to a subject in need thereof a therapeutically effectiveamount of a dendrimer, as described herein, wherein the cancer ismetastatic castration-resistant prostate cancer, the subject has notreceived primary granulocyte colony stimulating factor (G-CSF)prophylaxis, and the subject is at least about 65 years of age.

The dendrimers of the present disclosure surprisingly achieve asustained pharmacokinetic profile for unconjugated or released drug.This sustained pharmacokinetic profile indicates that the drug will bepresent in vivo at therapeutically effective levels for longer periodsof time. It will be appreciated that exposure to the drug for a longerperiod of time is desirable as it may prolong the therapeutic effect ofthe drug and allow for reduced frequency of dosing. In some embodiments,administration of the dendrimer provides a therapeutically effectiveplasma concentration of cabazitaxel for a longer period of time, incomparison to administration of an equivalent dose of free cabazitaxel.

In addition to having a sustained in vivo pharmacokinetic profileproviding comparatively longer therapeutic levels of exposure, thedendrimers also achieve comparatively low Cmax levels upon in vivoadministration.

In some embodiments, administration of the dendrimer provides a lowermaximal concentration (Cmax) of unconjugated/released drug in comparisonto direct administration of an equivalent dose of free drug. The maximalconcentration (Cmax) of drug is the maximum (or peak) serumconcentration that a drug achieves in a specified compartment or testarea of the body after the drug has been administered and before theadministration of a second dose. It will be appreciated that, whilst itis important to be able to dose a pharmaceutical agent at a levelsufficient to achieve therapeutic concentration levels, if the maximumconcentration levels reached are high, the risk of encountering certainoff-target effects, side-effects and toxicity increase. This isparticularly an issue for compounds which have a short half-life, sincein such cases, in order to provide therapeutically effective levels ofthe active agent for a prolonged period of time, it may be necessary toincrease the dose and thus the Cmax such that the likelihood of sideeffects increases. Accordingly, it is highly desirable to be able todeliver a pharmaceutically active agent in a form which providestherapeutically effective levels for a sustained period of time, whilstat the same time avoiding dosing at levels that achieve very highmaximum concentrations (Cmax) in vivo.

In some embodiments, the dendrimer has a lower maximal concentration(Cmax) of unconjugated/released cabazitaxel in comparison to the directadministration of an equivalent dose of free cabazitaxel. In someembodiments, the dendrimer has a lower maximal concentration (Cmax) ofreleased/unconjugated cabazitaxel in comparison to the directadministration of an equivalent dose of free cabazitaxel when used in amethod of treatment, for example, in the treatment of cancer, such asoesophageal cancer, thymic cancer, hepatobiliary cancer, head and necksquamous cell carcinomas, non-small cell lung carcinoma, cervicalcancer, digital papillary adenocarcinoma, breast cancer, ovarian cancer,pancreatic cancer or prostate cancer, e.g. hormone-refractory prostatecancer, metastatic castration-resistant prostate cancer (mCRPC).

In some embodiments, the dendrimer has a lower maximal concentration(Cmax) of unconjugated/released cabazitaxel in comparison to the directadministration of a dose of 20 or 25 mg/m² cabazitaxel. In someembodiments, the dendrimer has a lower maximal concentration (Cmax) ofreleased/unconjugated cabazitaxel in comparison to the directadministration of a dose of 20 or 25 mg/m² cabazitaxel, when used in amethod of treatment, for example, in the treatment of cancer, such asoesophageal cancer, thymic cancer, hepatobiliary cancer, head and necksquamous cell carcinomas, non-small cell lung carcinoma, cervicalcancer, digital papillary adenocarcinoma, breast cancer, ovarian cancer,pancreatic cancer or prostate cancer, e.g. hormone-refractory prostatecancer, metastatic castration-resistant prostate cancer (mCRPC).

In some embodiments, administration of the dendrimer provides a maximalconcentration (Cmax) of drug (i.e. released/unconjugated cabazitaxel)which is less than 90%, less than 50%, less than 40%, less than 30%,less than 20%, less than 10%, or less than 5% of the Cmax which resultsfrom direct administration of an equivalent dose of free cabazitaxel.

In some embodiments, an amount of dendrimer is administered which issufficient to provide a maximal concentration (Cmax) of unconjugatedCabazitaxel of less than 800, less than 500, less than 200, less than100, less than 50, less than 25, or less than 20 ng/mL. In someembodiments, an amount of dendrimer is administered which provides amaximal concentration (Cmax) of unconjugated/released cabazitaxel ofabout 10, about 15, about 20, about 25, about 30, about 35, about 40,about 45, about 50, about 55, about 60, about 65, about 70, about 75,about 80, about 85, about 80, about 95 or about 100 ng/mL.

AUC is the area under the curve in a plot of drug concentration in bloodplasma versus time. The AUC represents the total drug exposure overtime. It will be appreciated that the AUC is normally proportional tothe total amount of drug delivered to the body.

It will be appreciated that, following administration of the dendrimer,and as some of the cabazitaxel is released from the dendrimer, there isboth unbound cabazitaxel present in the body, and cabazitaxel presentwhich is still bound to dendrimer.

In some embodiments, administration of the dendrimer provides greaterAUC of total cabazitaxel (i.e. both dendrimer-bound cabazitaxel andreleased cabazitaxel), in comparison to direct administration of anequivalent dose of free cabazitaxel.

In some embodiments, administration of the dendrimer provides greaterAUC of total cabazitaxel (i.e. both dendrimer-bound cabazitaxel andreleased cabazitaxel), in comparison to the direct administration of anequivalent dose of free cabazitaxel when used in a method of treatment,for example, in the treatment of cancer, such as oesophageal cancer,thymic cancer, hepatobiliary cancer, head and neck squamous cellcarcinomas, non-small cell lung carcinoma, cervical cancer, digitalpapillary adenocarcinoma, breast cancer, ovarian cancer, pancreaticcancer or prostate cancer, e.g. hormone-refractory prostate cancer,metastatic castration-resistant prostate cancer (mCRPC). In someembodiments, administration of the dendrimer provides at least 1.5times, at least 2 times, at least 3 times, at least 4 times, or at least5 times the AUC of total cabazitaxel (i.e. both dendrimer-boundcabazitaxel and released cabazitaxel) in comparison to the directadministration of an equivalent dose of free cab azitaxel.

In some embodiments, administration of the dendrimer provides greaterAUC of total cabazitaxel (i.e. both dendrimer-bound cabazitaxel andreleased cabazitaxel in comparison to the direct administration of adose of 20 or 25 mg/m² cabazitaxel, when used in a method of treatment,for example, in the treatment of cancer, such as oesophageal cancer,thymic cancer, hepatobiliary cancer, head and neck squamous cellcarcinomas, non-small cell lung carcinoma, cervical cancer, digitalpapillary adenocarcinoma, breast cancer, ovarian cancer, pancreaticcancer or prostate cancer, e.g. hormone-refractory prostate cancer,metastatic castration-resistant prostate cancer (mCRPC). In someembodiments, administration of the dendrimer provides at least 1.5times, at least 2 times, at least 3 times, at least 4 times, or at least5 times the AUC of total cabazitaxel (i.e. both dendrimer-boundcabazitaxel and released cabazitaxel) in comparison to the in comparisonto the direct administration of a dose of 20 or 25 mg/m² cabazitaxel.

In some embodiments, an amount of dendrimer is administered whichprovides an AUC of total cabazitaxel (i.e. both dendrimer-boundcabazitaxel and released cabazitaxel) of at least 100,000, at least110,000, at least 120,000, at least 130,000, at least 140,000, at least150,000, at least 160,000, at least 170,000, at least 180,000, at least190,000, or at least 200,000 ng·h/mL. In some embodiments, an amount ofdendrimer is administered which provides an AUC of total cabazitaxel(i.e. both dendrimer-bound cabazitaxel and released cabazitaxel) ofabout 150,000, about 160,000, about 170,000, about 180,000, about190,000, about 200,000, about 210,000, about 220,000 or about 230,000ng·h/mL.

In some embodiments, administration of the dendrimer provides equivalentor greater AUC of unconjugated/released cabazitaxel in comparison to thedirect administration of an equivalent dose of free cabazitaxel.

In some embodiments, administration of the dendrimer provides at least1.1 times, at least 1.2 times, at least 1.3 times, at least 1.4 times,at least 1.5 times, at least 1.6 times, at least 1.7 times, at least 1.8times, at least 1.9 times, at least 2 times, at least 2.5 times, atleast 3 times, at least 3.5 times, or at least 4 times, the AUC ofunconjugated/released cabazitaxel in comparison to the directadministration of an equivalent dose of free cabazitaxel.

In some embodiments, administration of the dendrimer provides from 0.8times to 1.2 times the AUC of unconjugated/released cabazitaxel, incomparison to the direct administration of an equivalent dose of freecabazitaxel.

In some embodiments, administration of the dendrimer provides equivalentor greater AUC of unconjugated/released cabazitaxel in comparison to thedirect administration of an equivalent dose of free cabazitaxel, whenused in a method of treatment, for example, in the treatment of cancer,such as oesophageal cancer, thymic cancer, hepatobiliary cancer, headand neck squamous cell carcinomas, non-small cell lung carcinoma,cervical cancer, digital papillary adenocarcinoma, breast cancer,ovarian cancer, pancreatic cancer or prostate cancer, e.g.hormone-refractory prostate cancer, metastatic castration-resistantprostate cancer (mCRPC).

In some embodiments, administration of the dendrimer provides equivalentor greater AUC of unconjugated/released cabazitaxel in comparison to thedirect administration of a dose of 20 or 25 mg/m² cabazitaxel. In someembodiments, administration of the dendrimer provides equivalent orgreater AUC of unconjugated/released cabazitaxel in comparison to thedirect administration of a dose of 20 mg/m² cabazitaxel.

In some embodiments, administration of the dendrimer provides at least1.1 times, at least 1.2 times, at least 1.3 times, at least 1.4 times,at least 1.5 times, at least 1.6 times, at least 1.7 times, at least 1.8times, at least 1.9 times, at least 2 times, at least 2.5 times, atleast 3 times, at least 3.5 times, or at least 4 times, the AUC ofunconjugated/released cabazitaxel in comparison to the directadministration of a dose of 20 or 25 mg/m² cabazitaxel. In someembodiments, administration of the dendrimer provides at least 1.1times, at least 1.2 times, at least 1.3 times, at least 1.4 times, atleast 1.5 times, at least 1.6 times, at least 1.7 times, at least 1.8times, at least 1.9 times, at least 2 times, at least 2.5 times, atleast 3 times, at least 3.5 times, or at least 4 times, the AUC ofunconjugated/released cabazitaxel in comparison to the directadministration of a dose of 20 mg/m² cabazitaxel.

In some embodiments, administration of the dendrimer provides from 0.8times to 1.2 times the AUC of unconjugated/released cabazitaxel, incomparison to the direct administration of a dose of 20 or 25 mg/m²cabazitaxel. In some embodiments, administration of the dendrimerprovides from 0.8 times to 1.2 times the AUC of unconjugated/releasedcabazitaxel, in comparison to the direct administration of a dose of 20mg/m² cabazitaxel.

In some embodiments, administration of the dendrimer provides equivalentor greater AUC of unconjugated/released cabazitaxel in comparison to thedirect administration of a dose of 20 or 25 mg/m² cabazitaxel, when usedin a method of treatment, for example, in the treatment of cancer, suchas oesophageal cancer, thymic cancer, hepatobiliary cancer, head andneck squamous cell carcinomas, non-small cell lung carcinoma, cervicalcancer, digital papillary adenocarcinoma, breast cancer, ovarian cancer,pancreatic cancer or prostate cancer, e.g. hormone-refractory prostatecancer, metastatic castration-resistant prostate cancer (mCRPC). In someembodiments, administration of the dendrimer provides equivalent orgreater AUC of unconjugated/released cabazitaxel in comparison to thedirect administration of a dose of 20 mg/m² cabazitaxel, when used in amethod of treatment, for example, in the treatment of cancer, such asoesophageal cancer, thymic cancer, hepatobiliary cancer, head and necksquamous cell carcinomas, non-small cell lung carcinoma, cervicalcancer, digital papillary adenocarcinoma, breast cancer, ovarian cancer,pancreatic cancer or prostate cancer, e.g. hormone-refractory prostatecancer, metastatic castration-resistant prostate cancer (mCRPC).

In some embodiments, an amount of dendrimer is administered whichprovides an AUC of released/unconjugated cabazitaxel of at least 500, atleast 600, at least 700, at least 800, at least 900, at least 1000, atleast 1100, at least 1200, at least 1300, at least 1400, at least 1500,at least 1750, at least 2000, at least 2500, at least 3000, at least3500, or at least 4000 ng·h/mL.

In some embodiments, an amount of dendrimer is administered whichprovides an AUC of released/unconjugated cabazitaxel of about 500, about600, about 700, about 800, about 900, about 1000, about 1100, about1200, about 1300, about 1400, about 1500, about 1600, about 1700, about1800, about 2000, about 2500, about 3000, about 3500, or about 4000g·h/mL.

Free cabazitaxel is characterized by a triphasic elimination profilewith an initial-phase half-life averaging 4 minutes, followed by anintermediate-phase half-life of 2 hours, and a prolonged terminal-phasehalf-life averaging 95 hours. In some embodiments, administration of thedendrimer provides a terminal phase half-life (t_(1/2)) forunconjugated/released cabazitaxel of at least 12 hours, at least 24hours, at least 30 hours, at least 40 hours, at least 48 hours, at least50 hours, or at least 75 hours.

It will be appreciated that any one or more of the above pharmacokineticproperties may provide better clinical efficacy in comparison to thedirect administration of the free drug. In some embodiments,administration of the dendrimer provides better efficacy of the drug, incomparison to the direct administration of an equivalent dose of thefree drug. In some embodiments, the dendrimer, provides an improvedefficacy property selected from the group consisting of progression freesurvival, time to progression, objective response rate (PR+CR), overallresponse rate, overall survival and duration of response, in comparisonto direct administration of an equivalent dose of free cabazitaxel.

Dendrimer Synthesis

The dendrimers of the present disclosure may be prepared by any suitablemethod, for example by reacting a cabazitaxel-containing precursor witha dendrimeric intermediate already containing a PEG group to introducethe pharmaceutically active agent, by reacting a PEG-containingprecursor with a dendrimeric intermediate already containing acabazitaxel residue, or by reacting an intermediate comprising theresidue of a lysine group, a cabazitaxel residue and a PEG group with adendrimeric intermediate. Accordingly, in a fifth aspect there isprovided a process for producing a dendrimer as defined herein,comprising:

a) reacting a cabazitaxel intermediate which is:

wherein X is —OH or a leaving group, or wherein X together with the C(O)group to which it is attached forms a carboxylate salt;

with a dendrimeric intermediate which comprises:

i) a core unit (C); and

ii) building units (BU), each building unit being a lysine residue or ananalogue thereof;

wherein the core unit is covalently attached to two building units viaamide linkages, each amide linkage being formed between a nitrogen atompresent in the core unit and the carbon atom of an acyl group present ina building unit;

the dendrimer being a five generation building unit dendrimer;

wherein building units of different generations are covalently attachedto one another via amide linkages formed between a nitrogen atom presentin one building unit and the carbon atom of an acyl group present inanother building unit;

the dendrimer further comprising:

a plurality of second terminal groups (T2) each comprising a PEG group;

wherein at least one third of the nitrogen atoms present in the outerbuilding units are each covalently attached to a second terminal group;

and wherein at least one third of the nitrogen atoms present in theouter building units are unsubstituted and available for reaction withthe first intermediate;

or a salt thereof;

under amide coupling conditions;

or

b) reacting a PEG intermediate which is:

wherein PEG Group is a PEG-containing group, andX is —OH or a leaving group, or wherein X together with the C(O) groupto which it is attached forms a carboxylate salt;

with a dendrimeric intermediate which comprises:

i) a core unit (C); and

ii) building units (BU), each building unit being a lysine residue or ananalogue thereof;

wherein the core unit is covalently attached to two building units viaamide linkages, each amide linkage being formed between a nitrogen atompresent in the core unit and the carbon atom of an acyl group present ina building unit;

the dendrimer being a five generation building unit dendrimer;

wherein building units of different generations are covalently attachedto one another via amide linkages formed between a nitrogen atom presentin one building unit and the carbon atom of an acyl group present inanother building unit;

the dendrimer further comprising:

a plurality of first terminal groups (T1) each comprising a cabazitazelresidue covalently attached to a diglycolyl linker group;

wherein at least one third of the nitrogen atoms present in the outerbuilding units are each covalently attached to a first terminal group;

and wherein at least one third of the nitrogen atoms present in theouter building units are unsubstituted;

or a salt thereof;

under amide coupling conditions;

or

c) reacting a surface unit intermediate which is:

wherein PEG Group is a PEG-containing group, andX is —OH or a leaving group, or wherein X together with the C(O) groupto which it is attached forms a carboxylate salt;

with a dendrimeric intermediate comprising:

i) a core unit (C); and

ii) building units (BU), each building unit being a lysine residue or ananalogue thereof;

wherein the core unit is covalently attached to two building units viaamide linkages, each amide linkage being formed between a nitrogen atompresent in the core unit and the carbon atom of an acyl group present ina building unit;

the dendrimeric intermediate being a four generation building unitdendrimeric intermediate;

wherein building units of different generations are covalently attachedto one another via amide linkages formed between a nitrogen atom presentin one building unit and the carbon atom of an acyl group present inanother building unit;

and wherein nitrogen atoms present in the outer building units of thedendrimeric intermediate are unsubstituted;

or a salt thereof;

under amide coupling conditions.

Process variants a), b) and c) involve formation of amide bonds byreaction of —C(O)X groups with amine groups present in the dendrimericintermediates. Any suitable amide formation conditions may be used.Examples of typical conditions include the use of a suitable solvent(for example dimethylformamide) optionally a suitable base, and at asuitable temperature (for example ambient temperature, e.g. in the rangeof from 15 to 30° C.). Where X is a leaving group, any suitable leavinggroup may be used, for example an activated ester. Where X is an —OHgroup or where X together with the C(O) group to which it is attachedforms a carboxylate salt, the group will typically be converted to asuitable leaving group prior to reaction with a dendrimericintermediate, for example by use of a suitable amide coupling reagentsuch as PyBOP.

Any suitable isolation and/or purification technique may be utilised,for example the dendrimer may be obtained by dissolution in a suitablesolvent (e.g. THF) and precipitation by addition into an antisolvent(e.g. MTBE).

The cabazitaxel intermediate used in variant a) may itself be obtained,for example, by reaction of cabazitaxel with diglycolic anhydride, forexample in the presence of a suitable solvent such as dichloromethaneand a suitable base such as triethylamine.

The surface unit intermediate used in variant c) may itself be obtained,for example, by:

i) reacting a PEG intermediate which is:

wherein PEG Group is a PEG-containing group, andX is —OH or a leaving group, or wherein X together with the C(O) groupto which it is attached forms a carboxylate salt;with

wherein PG1 is an amine protecting group (such as a Boc or Cbz group),and PG2 is an acid protecting group (such as a methyl or benzyl ester);

ii) deprotecting PG1;

iii) reacting the product of step ii) with a cabazitaxel intermediatewhich is:

wherein X is —OH or a leaving group, or wherein X together with the C(O)group to which it is attached forms a carboxylate salt; and

iv) deprotecting PG2.

The dendrimeric intermediate used in variant a) may itself be obtainedby, for example, a sequential process involving:

i) reaction of a core unit (C) containing amino groups, with buildingunits which are protected lysines or analogues thereof, which contain a—C(O)X group, wherein X is —OH or a leaving group or —CO(X) forms acarboxylate salt, and in which the amino groups present in the lysinesor analogues thereof are protected, to form amide linkages between thecore unit and building units;

ii) deprotecting protecting groups present on the building units;

iii) reacting free amino groups present on the building units withfurther building units which are protected lysines or analogues thereof,which contain a —C(O)X group, wherein X is —OH or a leaving group or—CO(X) forms a carboxylate salt, and in which the amino groups presentin the lysines or analogues thereof are protected, to form amidelinkages between the different generations of building units;

iv) deprotecting protecting groups present on the building units;

v) repeating steps iii) and iv) until a four generation building unit isproduced;

vi) reacting free amino groups present on the building units with

wherein PG is a protecting group, and wherein X is —OH or a leavinggroup, or wherein X together with the C(O) group to which it is attachedforms a carboxylate salt, to form amide linkages therebetween; and

vii) deprotecting the protecting groups PG.

-   -   Alternatively, the dendrimeric intermediate used in variant a)        may be obtained, for example, by carrying out steps i) to v) as        described above, and:

vi) reacting free amino groups present on the building units withfurther building units which are protected lysines or analogues thereof,which contain a —C(O)X group, wherein X is —OH or a leaving group or—CO(X) forms a carboxylate salt, and in which the amino groups presentin the lysines or analogues thereof are orthogonally protected, to formamide linkages between the different generations of building units;

vii) deprotecting a first set of amino protecting groups;

viii) reacting free amino groups present on the building units with

wherein PEG Group is a PEG-containing group, and X is —OH or a leavinggroup, or wherein X together with the C(O) group to which it is attachedforms a carboxylate salt;

vii) deprotecting a second set of amino protecting groups.

The dendrimeric intermediate used in variant b) may itself be obtained,for example, by carrying out steps i) to v) as described above inrelation to variant a), and:

vi) reacting free amino groups present on the building units with

wherein PG is a protecting group, and wherein X is —OH or a leavinggroup, or wherein X together with the C(O) group to which it is attachedforms a carboxylate salt, to form amide linkages therebetween; and

vii) deprotecting the protecting groups PG.

-   -   Alternatively, the dendrimeric intermediate used in variant b)        may be obtained, for example, by carrying out steps i) to v) as        described above, and:

vi) reacting free amino groups present on the building units withfurther building units which are protected lysines or analogues thereof,which contain a —C(O)X group, wherein X is —OH or a leaving group or—CO(X) forms a carboxylate salt, and in which the amino groups presentin the lysines or analogues thereof are orthogonally protected, to formamide linkages between the different generations of building units;

vii) deprotecting a first set of amino protecting groups;

viii) reacting free amino groups present on the building units with

wherein X is —OH or a leaving group, or wherein X together with the C(O)group to which it is attached forms a carboxylate salt;

vii) deprotecting a second set of amino protecting groups.

The dendrimeric intermediate used in variant c) may itself be obtained,for example, by carrying out steps i) to v) as described above inrelation to variant a).

The present disclosure also provides synthetic intermediates useful inproducing the dendrimers. Accordingly, there is also provided anintermediate for producing a dendrimer which is

wherein X is —OH or a leaving group, or wherein X together with the C(O)group to which it is attached forms a carboxylate salt. Such anintermediate may be produced, for example, as described above.

There is also provided an intermediate for producing a dendrimer whichis

wherein PEG Group is a PEG-containing group, andX is —OH or a leaving group, or wherein X together with the C(O) groupto which it is attached forms a carboxylate salt. Such an intermediatemay be produced, for example, as described above.The present disclosure also relates to the following numbered clauses:1. A dendrimer comprising:

i) a core unit (C); and

ii) building units (BU), each building unit being a lysine residue or ananalogue thereof;

wherein the core unit is covalently attached to two building units viaamide linkages, each amide linkage being formed between a nitrogen atompresent in the core unit and the carbon atom of an acyl group present ina building unit;

the dendrimer being a five generation building unit dendrimer;

wherein building units of different generations are covalently attachedto one another via amide linkages formed between a nitrogen atom presentin one building unit and the carbon atom of an acyl group present inanother building unit;

the dendrimer further comprising:

iii) a plurality of first terminal groups (T1) each comprising acabazitazel residue covalently attached to a diglycolyl linker group;and

iv) a plurality of second terminal groups (T2) each comprising a PEGgroup;

wherein at least one third of the nitrogen atoms present in outerbuilding units are each covalently attached to a first terminal group;and

at least one third of the nitrogen atoms present in outer building unitsare each covalently attached to a second terminal group;

or a pharmaceutically acceptable salt thereof.2. A dendrimer according to clause 1, wherein the core is:

3. A dendrimer according to clauses 1 or 2, wherein the building unitsare each:

wherein the acyl group of each building unit provides a covalentattachment point for attachment to the core or to a previous generationbuilding unit; and wherein each nitrogen atom provides a covalentattachment point for covalent attachment to a subsequent generationbuilding unit, a first terminal group or a second terminal group.4. A dendrimer according to clause 3, wherein the building units areeach:

5. A dendrimer according to clauses 1 to 4, wherein the dendrimer hasfive complete generations of building units.6. A dendrimer according to clauses 1 to 5, wherein each first terminalgroup (T1) is:

7. A dendrimer according to clauses 1 to 6, wherein the second terminalgroups comprise PEG groups having an average molecular weight in therange of from 1000 to 2500 Daltons.8. A dendrimer according to clauses 1 to 7, wherein the second terminalgroups each comprise a PEG group covalently attached to a PEG linkinggroup (L1) via an ether linkage formed between a carbon atom present inthe PEG group and an oxygen atom present in the PEG linking group, andeach second terminal group is covalently attached to a building unit viaan amide linkage formed between a nitrogen atom present in a buildingunit and the carbon atom of an acyl group present in the PEG linkinggroup.9. A dendrimer according to clause 8, wherein the second terminal groupsare each

and wherein the PEG group is a methoxy-terminated PEG having an averagemolecular weight in the range of from about 1750 to 2500 Daltons.10. A dendrimer according to clause 9, wherein the dendrimer comprisessurface units comprising an outer building unit attached to a firstterminal group and a second terminal group, the surface units having thestructure:

and wherein the PEG group is a methoxy-terminated PEG having an averagemolecular weight in the range of from about 1750 to 2500 Daltons.11. A dendrimer according to clause 10, wherein the dendrimer has from28 to 32 surface units, preferably from 30 to 32 surface units.12. A dendrimer according to clauses 1 to 11, wherein at least 40% ofthe nitrogen atoms present in the outer building units are eachcovalently attached to a first terminal group; and at least 40% of thenitrogen atoms present in the outer building units are each covalentlyattached to a second terminal group.13. A dendrimer according to clauses 1 to 12, wherein the fivegenerations of building units are complete generations, and wherein theouter generation of building units provides 64 nitrogen atoms forcovalent attachment to a first terminal group or a second terminal,wherein from 26 to 32 first terminal groups are covalently attached toone of said nitrogen atoms, and wherein from 28 to 32 second terminalgroups are each covalently attached to one of said nitrogen atoms.14. A dendrimer according to clauses 1 to 13, wherein the cabazitaxelresidues comprise a w/w % of the dendrimer in the range of from 23% w/wto 28% w/w.15. A dendrimer according to clauses 1 to 14, wherein the dendrimer is:

in which T1′ represents a first terminal group which is

or T1′ represents H, wherein less than 5 of T1′ are H; andT2′ represents a second terminal group which is

wherein the PEG group is a methoxy-terminated PEG having an averagemolecular weight in the range of from about 1750 to 2500 Daltons, or T2′represents H, and wherein less than 5 of T2′ are H.16. A dendrimer according to clauses 1 to 15, wherein the in vitrohalf-life for cabazitaxel release from the dendrimer in PBS at pH 7.4and at 37° C. is in the range of from 20 to 100 hours.17. A dendrimer according to clause 16, wherein the in vitro half-lifefor cabazitaxel release from the dendrimer in PBS at pH 7.4 and at 37°C. is in the range of from 30 to 60 hours.18. A composition comprising a plurality of dendrimers orpharmaceutically acceptable salts thereof,

wherein the dendrimers are according to clauses 1 to 17,

the mean number of first terminal groups per dendrimer in thecomposition is in the range of from 24 to 32, and

the mean number of second terminal groups per dendrimer in thecomposition is in the range of from 24 to 32.

19. A composition according to clause 17, wherein the cabazitaxelresidues comprise a w/w % of the dendrimers in the composition in therange of from 23% w/w to 28% w/w.20. A composition according to clause 19, wherein the composition is apharmaceutical composition, and wherein the composition comprises apharmaceutically acceptable excipient.21. A pharmaceutical composition comprising:i) a dendrimer according to clauses 1 to 17, or a pharmaceuticallyacceptable salt thereof, and ii) a pharmaceutically acceptableexcipient.22. A pharmaceutical composition according to clause 21, wherein thecomposition is a solid composition comprising a dendrimer according toclauses 1 to 17, a sugar and an acid, and wherein the composition is forreconstitution with a diluent.23. A pharmaceutical composition according to clause 22, wherein thesugar is trehalose and the acid is citric acid.24. A composition according to clause 22 or 23, wherein, followingreconstitution with a diluent, the reconstituted composition has a pH inthe range of from 3.5 to 5.5.25. A pharmaceutical composition according to clauses 21 to 24, whereinthe composition is free or substantially free of polyethoxylated castoroil and polyethoxylated sorbitan monooleate.26. A pharmaceutical composition according to clauses 21 to 25, whereinthe composition is formulated for administration as an infusion over atime period of up to 30 minutes, or wherein the composition isformulated for administration as a bolus over a time period of up to 5minutes.27. A dendrimer according to clauses 1 to 17, or a pharmaceuticalcomposition as claimed in any of claims 21 to 26, for use in therapy.28. A dendrimer according to clauses 1 to 17, or a pharmaceuticalcomposition according to clauses 21 to 26, for use in the treatment ofcancer.29. A method of treating cancer comprising administering to a subject inneed thereof a therapeutically effective amount of a dendrimer accordingto clauses 1 to 17 or a pharmaceutical composition according to clauses21 to 26.30. Use of a dendrimer according to clauses 1 to 17, or of a compositionaccording to clauses 21 to 26, in the manufacture of a medicament forthe treatment of cancer.31. A method, use, or dendrimer or composition for use, according toclauses 28 to 30, wherein the cancer is selected from the groupconsisting of pancreatic cancer, prostate cancer, breast cancer andovarian cancer.32. A method, use, or dendrimer or composition for use, according toclause 31, wherein the cancer is metastatic castration-resistantprostate cancer (mCRPC).33. A method, use, or dendrimer or composition for use according toclauses 28 to 32, wherein the therapeutically effective amount of thedendrimer is in the range of from 10 to 100 mg/m² body surface area.34. A method, use, or dendrimer or composition for use according toclause 33, wherein the therapeutically effective amount of the dendrimeris in the range of from 20 to 50 mg/m² body surface area.35. A method, use, or dendrimer or composition for use according toclause 34, wherein the wherein the therapeutically effective amount ofthe dendrimer is in the range of from 50 to 100 mg/m² body surface area.36. A method, use, or dendrimer or composition for use according toclauses 28 to 35, wherein the composition is administered as an infusionover a time period of up to 30 minutes, or wherein the composition isadministered as a bolus over a time period of up to 5 minutes.37. A method, use, or dendrimer or composition for use according toclauses 28 to 36, wherein the dendrimer is administered in combinationwith a further therapeutic agent.38. A method, use, or dendrimer or composition for use according toclause 37, wherein the further therapeutic agent is a furtheranti-cancer drug.39. A method, use, or dendrimer or composition for use according toclauses 28 to 38, wherein the dendrimer is

in which T1′ represents a first terminal group which is

or T1′ represents H, wherein less than 5 of T1′ are H; andT2′ represents a second terminal group which is

wherein the PEG group is a methoxy-terminated PEG having an averagemolecular weight in the range of from about 1750 to 2500 Daltons, or T2′represents H, and wherein less than 5 of T2′ are H.40. A method, use, or dendrimer or composition for use according toclauses 28 to 39, wherein administration of the dendrimer provides atherapeutically effective plasma concentration of cabazitaxel for alonger period of time, in comparison to administration of an equivalentdose of free cabazitaxel.41. A method, use, or dendrimer or composition for use according toclauses 28 to 40, wherein administration of the dendrimer provides amaximal concentration (Cmax) of cabazitaxel which is no more than 20% ofthe maximal concentration provided by administration of an equivalentdose of free cab azitaxel.42. A method use, or dendrimer of composition for use according toclauses 28 to 41, wherein administration of the dendrimer providesgreater AUC of total cabazitaxel, in comparison to direct administrationof an equivalent dose of free cabazitaxel.43. A method, use, or dendrimer or composition for use according toclauses 28 to 42, wherein administration of the dendrimer providesenhanced clinical efficacy in comparison to administration of anequivalent dose of free cabazitaxel.44. A method, use, or dendrimer or composition for use according toclauses 28 to 42, wherein administration of a course of the dendrimerprovides enhanced clinical efficacy in comparison to three-weeklyadministration of 20 or 25 mg/m² cabazitaxel.45. A method, use or dendrimer or composition for use according toclauses 28 to 44, wherein administration of the dendrimer providesreduced neutropenia, lymphopenia, anemia, and/or thrombocytopenia incomparison to administration of an equivalent dose of free cabazitaxel.46. A method, use or dendrimer or composition for use according toclauses 28 to 44, wherein administration of the dendrimer providesreduced neutropenia, lymphopenia, anemia, and/or thrombocytopenia incomparison to three-weekly administration of 20 or 25 mg/m² cabazitaxel.47. A process for producing a dendrimer according to clauses 1 to 17,comprising:

a) reacting a cabazitaxel intermediate which is:

wherein X is —OH or a leaving group, or wherein X together with the C(O)group to which it is attached forms a carboxylate salt;

with a dendrimeric intermediate which comprises:

i) a core unit (C); and

ii) building units (BU), each building unit being a lysine residue or ananalogue thereof;

wherein the core unit is covalently attached to two building units viaamide linkages, each amide linkage being formed between a nitrogen atompresent in the core unit and the carbon atom of an acyl group present ina building unit;

the dendrimer being a five generation building unit dendrimer;

wherein building units of different generations are covalently attachedto one another via amide linkages formed between a nitrogen atom presentin one building unit and the carbon atom of an acyl group present inanother building unit;

the dendrimer further comprising:

a plurality of second terminal groups (T2) each comprising a PEG group;

wherein at least one third of the nitrogen atoms present in the outerbuilding units are each covalently attached to a second terminal group;

and wherein at least one third of the nitrogen atoms present in theouter building units are unsubstituted and available for reaction withthe first intermediate;

or a salt thereof;

under amide coupling conditions;

or

b) reacting a PEG intermediate which is:

wherein PEG Group is a PEG-containing group, andX is —OH or a leaving group, or wherein X together with the C(O) groupto which it is attached forms a carboxylate salt;

with a dendrimeric intermediate which comprises:

i) a core unit (C); and

ii) building units (BU), each building unit being a lysine residue or ananalogue thereof;

wherein the core unit is covalently attached to two building units viaamide linkages, each amide linkage being formed between a nitrogen atompresent in the core unit and the carbon atom of an acyl group present ina building unit;

the dendrimer being a five generation building unit dendrimer;

wherein building units of different generations are covalently attachedto one another via amide linkages formed between a nitrogen atom presentin one building unit and the carbon atom of an acyl group present inanother building unit;

the dendrimer further comprising:

a plurality of first terminal groups (T1) each comprising a cabazitazelresidue covalently attached to a diglycolyl linker group;

wherein at least one third of the nitrogen atoms present in the outerbuilding units are each covalently attached to a first terminal group;

and wherein at least one third of the nitrogen atoms present in theouter building units are unsubstituted;

or a salt thereof;

under amide coupling conditions;

or

c) reacting a surface unit intermediate which is:

wherein PEG Group is a PEG-containing group, andX is —OH or a leaving group, or wherein X together with the C(O) groupto which it is attached forms a carboxylate salt;

with a dendrimeric intermediate comprising:

i) a core unit (C); and

ii) building units (BU), each building unit being a lysine residue or ananalogue thereof;

wherein the core unit is covalently attached to two building units viaamide linkages, each amide linkage being formed between a nitrogen atompresent in the core unit and the carbon atom of an acyl group present ina building unit;

the dendrimeric intermediate being a four generation building unitdendrimeric intermediate;

wherein building units of different generations are covalently attachedto one another via amide linkages formed between a nitrogen atom presentin one building unit and the carbon atom of an acyl group present inanother building unit;

and wherein nitrogen atoms present in the outer building units of thedendrimeric intermediate are unsubstituted;

or a salt thereof;

under amide coupling conditions.

48. An intermediate for producing a dendrimer which is

wherein X is —OH or a leaving group, or wherein X together with the C(O)group to which it is attached forms a carboxylate salt.49. An intermediate for producing a dendrimer which is

wherein PEG Group is a PEG-containing group, andX is —OH or a leaving group, or wherein X together with the C(O) groupto which it is attached forms a carboxylate salt.

The present disclosure will now be described with reference to thefollowing examples which illustrate some particular aspects of thepresent disclosure. However, it is to be understood that theparticularity of the following description of the present disclosure isnot to supersede the generality of the preceding description of thepresent disclosure.

EXAMPLES Example 1: Synthesis and Characterization ofBHALys[Lys]₃₂[α-NH₂TFA]₃₂[ε-PEG˜2100]_(32‡)

The dendrimers represented in the examples below include reference tothe core and the building units in the outermost generation of thedendrimer. The subsurface generations are not depicted. The dendrimerBHALys[Lys]₃₂ is representative of a 5 generation dendrimer having theformula BHALys[Lys]₂[Lys]₄[Lys]₈[Lys]₁₆[Lys]₃₂.

32‡ relates to the theoretical number of ε surface amino groups on thedendrimer available for substitution with PEG_(˜2100). The actual meannumber of PEG_(˜2100) groups attached to the BHALys[Lys]₃₂ wasdetermined experimentally by ¹H NMR (see below section in the presentExample entitled Characterization ofBHALys[Lys]₃₂[α-NH₂-TFA]₃₂[ε-PEG_(˜2100)]_(32‡)).

BHALys[Boc]₂

Solid α,ε-(t-Boc)₂-(L)-lysine p-nitrophenol ester (2.787 kg, 5.96 mol)was added to a solution of aminodiphenylmethane (benzhydrylamine) (0.99kg, 5.4 mol) in anhydrous acetonitrile (4.0 L), DMF (1.0 L) andtriethylamine (1.09 kg) over a period of 15 min. The reaction mixturewas agitated at 20° C. overnight. The reaction mixture was then warmedto 35° C. and aqueous sodium hydroxide (0.5 N, 10 L) was added slowlyover 30 min. The mixture was stirred for an additional 30 min thenfiltered. The solid cake was washed with water and dried to a constantweight (2.76 kg, 5.4 mol) in 100% yield. ¹H NMR (CD₃OD) δ 7.3 (m, 10H,Ph Calc 10H); 6.2 (s, 1H, CH-Ph₂ Calc 1H); 4.08 (m, α-CH, 1H), 3.18 (br,ε—CH₂) and 2.99 (m, ε—CH₂ 2H); 1.7-1.2 (br, β,γ,δ-CH₂) and 1.43 (s, tBu)total for β,γ,δ-CH₂ and tBu 25H Calc 24H. MS (ESI +ve) found 534.2[M+Na]⁺. calc for C₂₉H₄₁N₃O₅Na [M+Na]⁺ 534.7.

BHALys[HCl]₂

A solution of concentrated HCl (1.5 L) in methanol (1.5 L) was addedslowly, in three portions, to a stirred suspension of BHALys[Boc]₂(780.5 g, 1.52 mol) in methanol (1.5 L) at a rate to minimize excessivefrothing. The reaction mixture was stirred for an additional 30 min,then concentrated under vacuum at 35° C. The residue was taken up inwater (3.4 L) and concentrated under vacuum at 35° C. twice, then storedunder vacuum overnight. Acetonitrile (3.4 L) was then added and theresidue was again concentrated under vacuum at 35° C. to giveBHALys[HCl]₂ as a white solid (586 g, 1.52 mol) in 100% yield. ¹H NMR(D₂O) δ 7.23 (br m, 10H, Ph Calc 10H); 5.99 (s, 1H, CH-Ph₂ Calc 1H);3.92 (t, J=6.5 Hz, α-CH, 1H, Calc 1H); 2.71 (t, J=7.8 Hz, ε-CH₂, 2H,Calc 2H); 1.78 (m, β,γ,δ-CH₂, 2H), 1.47 (m, β,γ,δ-CH₂, 2H), and 1.17 (m,β,γ,δ-CH₂, 2H, total 6H Calc 6H). MS (ESI +ve) found 312 [M+H]⁺. calcfor C₁₉H₂₆N₃O [M+H]⁺ 312.

BHALys[Lys]₂[Boc]₄

To a suspension of BHALys[HCl]₂ (586 g, 1.52 mmol) in anhydrous DMF (3.8L) was added triethylamine (1.08 kg) slowly to maintain the reactiontemperature below 30° C. Solid α,ε-(t-Boc)₂-(L)-lysine p-nitrophenolester (1.49 kg) was added in three portions, slowly and with stirringfor 2 hours between additions. The reaction was allowed to stirovernight. An aqueous solution of sodium hydroxide (0.5 M, 17 L) wasadded slowly to the well stirred mixture, and stirring was maintaineduntil the solid precipitate was freely moving. The precipitate wascollected by filtration, and the solid cake was washed well with water(2×4 L) then acetone/water (1:4, 2×4 L). The solid was slurried againwith water then filtered and dried under vacuum overnight to give BHALys[Lys]₂[Boc]₄ (1.51 kg) in 100% yield. ¹H NMR (CD₃OD) δ 7.3 (m, 10H, PhCalc 10H); 6.2 (s, 1H, CH-Ph₂ Calc 1H); 4.21 (m, α-CH), 4.02 (m, α-CH)and 3.93 (m, α-CH, total 3H, Calc 3H); 3.15 (m, ε—CH₂) and 3.00 (m,ε—CH₂ total 6H, Calc 6H); 1.7-1.3 (br, β,γ,δ-CH₂) and 1.43 (s, tBu)total for β,γ,δ-CH₂ and tBu 57H, Calc 54H. MS (ESI +ve) found 868.6[M-Boc]⁺; 990.7 [M+Na]⁺. calc for C₅₁H₈₁N₇O₁₁Na [M+Na]⁺ 991.1.

BHALys[Lys]₂[HCl]₄

BHALys[Lys]₂[Boc]₄ (1.41 kg, 1.46 mol) was suspended in methanol (1.7 L)with agitation at 35° C. Hydrochloric acid (1.7 L) was mixed withmethanol (1.7 L), and the resulting solution was added in four portionsto the dendrimer suspension and left to stir for 30 min. The solvent wasremoved under reduced pressure and worked up with two successive water(3.5 L) strips followed by two successive acetonitrile (4 L) strips togive BHALys[Lys]2[HCl]4 (1.05 Kg, 1.46 mmol) in 102% yield. ¹H NMR (D₂O)δ 7.4 (br m, 10H, Ph Calc 10H); 6.14 (s, 1H, CH-Ph₂ Calc 1H); 4.47 (t,J=7.5 Hz, α-CH, 1H), 4.04 (t, J=6.5 Hz, α-CH, 1H), 3.91 (t, J=6.8 Hz,α-CH, 1H, total 3H, Calc 3H); 3.21 (t, J=7.4 Hz, ε-CH₂, 2H), 3.01 (t,J=7.8 Hz, ε-CH₂, 2H) and 2.74 (t, J=7.8 Hz, ε-CH₂, 2H, total 6H, Calc6H); 1.88 (m, β,γ,δ-CH₂), 1.71 (m, β,γ,δ-CH₂), 1.57 (m, β,γ,δ-CH₂) and1.35 (m, β,γ,δ-CH₂ total 19H, Calc 18H).

BHALys[Lys]₄[Boc]₈

BHALys[Lys]₂[HCl]₄ (1.05 Kg, 1.47 mol) was dissolved in DMF (5.6 L) andtriethylamine (2.19 L). The α,ε-(t-Boc)₂-(L)-lysine p-nitrophenol ester(2.35 kg, 5.03 mol) was added in three portions and the reaction stirredovernight at 25° C. A NaOH (0.5M, 22 L) solution was added and theresulting mixture filtered, washed with water (42 L) and then air dried.The solid was dried under vacuum at 45° C. to give BHALys [Lys]₄[Boc]₈(2.09 kg, 1.11 mol) in 76% yield. ¹H NMR (CD₃OD) δ 7.3 (m, 10H, Ph Calc10H); 6.2 (s, 1H, CH-Ph₂ Calc 1H); 4.43 (m, α-CH), 4.34 (m, α-CH), 4.25(m, α-CH) and 3.98 (br, α-CH, total 7H, Calc 7H); 3.15 (br, ε—CH₂) and3.02 (br, ε—CH₂ total 14H, Calc 14H); 1.9-1.2 (br, β,γ,δ-CH₂) and 1.44(br s, tBu) total for β,γ,δ-CH₂ and tBu 122H, Calc 144H.

BHALys[Lys]₄[TFA]₈

To a stirred suspension of BHALys[Lys]₄[Boc]₈ (4 g, 2.13 mmol) in DCM(18 mL) was added TFA (13 mL) at 0° C. The solids dissolved, and thesolution was stirred overnight under an atmosphere of argon. Thesolvents were removed under vacuum, and residual TFA was removed bytrituration with diethyl ether (100 mL). The product was re-dissolved inwater then freeze dried to give BHALys[Lys]₄[TFA]₈ as an off-white solid(4.27 g, 2.14 mmol) in 101% yield. ¹H NMR (D₂O) δ 7.21 (br m, 10H, PhCalc 10H); 5.91 (s, 1H, CH-Ph₂ Calc 1H); 4.17 (t, J=7.4 Hz, α-CH, 1H),4.09 (t, J=7.1 Hz, α-CH, 1H), 4.02 (t, J=7.2 Hz, α-CH, 1H, 3.84 (t,J=6.5 Hz, α-CH, 2H), 3.73 (t, J=6.7 Hz, α-CH, 1H), 3.67 (t, J=6.7 Hz,α-CH, 1H, total 7H, Calc 7H); 3.0 (m, ε—CH₂), 2.93 (m, ε—CH₂) and 2.79(b, ε—CH₂, total 15H, Calc 14H); 1.7 (br, β,γ,δ-CH₂), 1.5 (br,β,γ,δ-CH₂), 1.57 (m, β,γ,δ-CH₂) and 1.25 (br, β,γ,δ-CH₂ total 45H, Calc42H). MS (ESI +ve) found 541.4 [M+2H]²⁺. calc for C₅₅H₉₉N₁₅O₇ [M+2H]²⁺541.2.

BHALys[Lys]₈[Boc]₁₆

A solution of α,ε-(t-Boc)₂-(L)-lysine p-nitrophenol ester (1.89 g, 4.05mmol) in DMF (25 mL) was added to a solution of BHALys [Lys]₄[NH₂TFA]₈(644 mg, 0.32 mmol) and triethylamine (0.72 mL, 5.2 mmol) in DMF (25 mL)and the reaction was left to stir overnight under an argon atmosphere.The reaction mixture was poured onto ice/water (500 mL) then filteredand the collected solid was dried overnight under vacuum. The driedsolid was washed thoroughly with acetonitrile to giveBHALys[Lys]₈[Boc]₁₆ as an off white solid (0.82 g, 0.22 mmol) in 68%yield. ¹H NMR (CD₃OD) δ 7.3 (m, 10H, Ph Calc 10H); 6.2 (br s, 1H, CH-Ph₂Calc 1H); 4.48 (br, α-CH), 4.30 (br, α-CH) and 4.05 (br, α-CH, total 16HCalc 15H); 3.18 (br, ε—CH₂) and 3.02 (m, ε—CH₂ total 31H, Calc 30H);1.9-1.4 (br, β,γ,δ-CH₂) and 1.47 (br s, tBu) total for β,γ,δ-CH₂ and tBu240H, Calc 234H. MS (ESI +ve) found 3509 [M+H-(Boc)₂]⁺. calc forC₁₇₃H₃₀₆N₃₁O₄₃[M+H-(Boc)₂]⁺ 3508.5; 3408 [M+H-(Boc)₃]⁺ calc forC₁₆₈H₂₉₈N₃₁O₄₁ [M+H-(Boc)₃]⁺ 3408.4.

BHALys[Lys]₈[TFA]₁₆

A solution of TFA/DCM (1:1, 19 mL) was added slowly to a stirredsuspension of BHALys[Lys]₈[Boc]16 (800 mg, 0.22 mmol) in DCM (25 mL).The solids dissolved, and the solution was stirred overnight under anatmosphere of argon. The solvents were removed under vacuum, andresidual TFA was removed by repetitive freeze drying of the residue, togive BHALys [Lys]₈[TFA]₁₆ as an off-white lyophylisate (848 mg, 0.22mmol) in 100% yield. ¹H NMR (D₂O) δ 7.3 (br m, 10H, Ph Calc 10H); 6.08(s, 1H, CH-Ph₂ Calc 1H); 4.3 (m, α-CH), 4.18 (m, α-CH), 4.0 (m, α-CH)and 3.89 (m, α-CH, total 16H, Calc 15H); 3.18 (br, ε—CH₂) and 2.94 (m,ε—CH₂ total 32H, Calc 30H); 1.9 (m, β,γ,δ-CH₂), 1.68 (m, β,γ,δ-CH₂) and1.4 (m, β,γ,δ-CH₂ total 99H, Calc 90H). MS (ESI +ve) found 2106 [M+H]⁺.calc for C₁₀₃H₁₉₄N₃₁O₁₅ [M+H]⁺ 2106.9.

BHALys[Lys]₁₆[Boc]₃₂

A solution of α,ε-(t-Boc)₂-(L)-lysine p-nitrophenol ester (1.89 g, 4.05mmol) in DMF (25 mL) was added to a solution of BHALys [Lys]₈[TFA]₁₆(644 mg, 0.32 mmol) and triethylamine (0.72 mL, 5.2 mmol) in DMF (25 mL)and the reaction was left to stir overnight under an argon atmosphere.The reaction was poured onto ice/water (500 mL) then filtered and thecollected solid was dried overnight under vacuum. The dried solid waswashed thoroughly with acetonitrile to give BHALys[Lys]₁₆[Boc]₃₂ as anoff white solid (0.82 g, 0.22 mmol) in 68% yield. ¹H NMR (CD₃OD) δ 7.28(m, 9H, Ph Calc 10H); 6.2 (br s, 1H, CH-Ph₂ Calc 1H); 4.53 (br, α-CH),4.32 (br, α-CH) and 4.05 (br, α-CH, total 35H, Calc 31H); 3.18 (br,ε—CH₂) and 3.04 (m, ε—CH₂ total 67H, Calc 62H); 1.9-1.5 (br, β,γ,δ-CH₂)and 1.47 (br s, tBu) total for β,γ,δ-CH₂ and tBu 474H Calc, 474H. MS(ESI +ve) found 6963 [M+H-(Boc)₄]⁺. calc for C₃₃₉H₆₀₁N₆₃O₈₇[M+H-(Boc)₄]⁺ 6960.9; 6862 [M+H-(Boc)₅]⁺ calc for C₃₃₄H₆₀₄N₆₃O₈₅[M+H-(Boc)₅]⁺ 6860.8.

BHALys[Lys]₁₆[TFA]₃₂

A solution of TFA/DCM (1:1, 19 mL) was added slowly to a stirredsuspension of BHALys[Lys]₁₆[Boc]₃₂ (800 mg, 0.11 mmol) in DCM (25 mL).The solids dissolved, and the solution was stirred overnight under anatmosphere of argon. The solvents were removed under vacuum, andresidual TFA was removed by repetitive freeze drying of the residue, togive BHALys[Lys]₁₆[TFA]₃₂ as an off-white lyophylate (847 mg, 0.11 mmol)in 100% yield. ¹H NMR (D₂O) δ 7.3 (br m, 11H, Ph Calc 10H); 6.06 (s, 1H,CH-Ph₂ Calc 1H); 4.3 (m, α-CH), 4.19 (m, α-CH), 4.0 (m, α-CH) and 3.88(m, α-CH, total 35H, Calc 31H); 3.15 (br, ε—CH₂) and 2.98 (m, ε—CH₂total 69H, Calc 62H); 1.88 (m, β,γ,δ—CH₂), 1.7 (m, β,γ,δ-CH₂) and 1.42(m, β,γ,δ-CH₂ total 215H, Calc 186H). MS (ESI +ve) found 4158 [M+H]⁺.calc for C₁₉₉H₃₈₆N₆₃O₃₁ [M+H]⁺ 4157.6.

HO-Lys(α-BOC)(ε-PEG_(˜2100))

DIPEA (0.37 mL, 2.10 mmol) was added to an ice-cooled mixture ofNHS-PEG_(˜2100) (2.29 g, 1.05 mmol) (in which PEG_(˜2100) represents amethoxy-terminated PEG group having approximate average molecular weightof 2100 Da, and in which NHS represents NHS—C(O)CH₂), andN-α-t-BOC-L-lysine (0.26 g, 1.05 mmol) in DMF (20 mL). The stirredmixture was allowed to warm to room temperature overnight then anyremaining solids were filtered (0.45 μm PALL acrodisc) before removingthe solvent in vacuo. The residue was taken up in ACN/H₂O (1:3, 54 mL)and purified by PREP HPLC (Waters XBridge C18, 5 μm, 19×150 mm, 25 to32% ACN (5-15 min), 32 to 60% ACN (15 to 20 min), no buffer, 8 mL/min,RT=17 min), providing 1.41 g (56%) of HO-Lys(BOC)(PEG₂₁₀₀). ¹H NMR(CD₃OD) δ 3.96-4.09 (m, 1H), 3.34-3.87 (m, 188H); 3.32 (s, 3H), 3.15 (q,J=6.0 Hz, 2H), 2.40 (t, J=6.2 Hz, 2H), 1.28-1.88 (m, 6H), 1.41 (s, 9H).

BHALys[Lys]₃₂[α-BOC]₃₂[ε-PEG_(˜2100)]_(32‡)

To a stirred mixture of BHALys[Lys]₁₆[TFA]₃₂ (0.19 g, 24 μmol) in DMF(20 mL) was added DIPEA (0.86 mL, 4.86 mmol). This mixture was thenadded dropwise to a stirred mixture of PyBOP (0.62 g, 1.20 mmol) andLys(BOC)(PEG_(˜2100)) (2.94 g, 1.20 mmol) in DMF (20 mL) at roomtemperature. The reaction mixture was left to stir overnight, thendiluted with water (200 mL). The aqueous mixture was subjected to acentramate filtration (5 k membrane, 20 L water). The retentate wasfreeze dried, providing 1.27 g (73%) of desired dendrimer. HPLC (C8XBridge, 3×100 mm, gradient: 5% ACN (0-1 min), 5-80% ACN/H₂O) (1-7 min),80% ACN (7-12 min), 80-5% ACN (12-13 min), 5% ACN (13-15 min), 214 nm,0.1% TFA) Rf (min)=8.52. 1H NMR (300 MHz, D₂O) δ (ppm): 1.10-2.10 (m,Lys CH₂ (β, χ, δ) and BOC, 666H), 3.02-3.36 (m, Lys CH₂ (c), 110H), 3.40(s, PEG-OMe, 98H), 3.40-4.20 (m, PEG-OCH₂, 5750H+Lys CH surface, 32H),4.20-4.50 (m, Lys, CH internal 32H), 7.20-7.54 (m, BHA, 8H). ¹H NMRindicates approximately 29 PEGs.

BHALys[Lys]₃₂[α-NH₂TFA]₃₂[ε-PEG_(˜2100)]_(32‡)

1.27 g (17.4 μmol) of BHALys[Lys]₃₂[α-BOC]₃₂[ε-PEG_(˜2100)]₃₂ wasstirred in TFA/DCM (1:1, 20 mL) at room temperature overnight. Thevolatiles were removed in vacuo, then the residue was taken up in water(30 mL). The mixture was then concentrated. This process was repeatedtwo more times before being freeze dried, providing 1.35 g (106%) ofdesired product as a viscous colourless oil. HPLC (C8)(Bridge, 3×100 mm,gradient: 5% ACN (0-1 min), 5-80% ACN/H₂O) (1-7 min), 80% ACN (7-12min), 80-5% ACN (12-13 min), 5% ACN (13-15 min), 214 nm, 0.1% TFA) Rf(min)=8.51. ¹H-nmr (300 MHz, D₂O) δ (ppm): 1.22-2.08 (Lys CH₂ ((β, χ,δ), 378H), 3.00-3.26 (Lys CH2 (ε), 129H), 3.40 (PEG-OMe, 96H), 3.45-4.18(PEG-OCH₂, 5610H+Lys CH surface, 32H), 4.20-4.46 (Lys, CH internal,33H), 7.24-7.48 (8H, BHA). ¹H NMR indicates approximately 29 PEGs.

Characterization of BHALys[Lys]₃₂[α-NH₂TFA]₃₂[ε-PEG_(˜2100)]_(32‡)

Table 1 illustrates the various batches ofBHALys[Lys]₃₂[α-NH₂TFA]₃₂[ε-PEG_(˜2100)]_(32#) synthesised. The actualnumber of PEG chains on the dendrimer is also calculated by ¹H NMR.

TABLE 1 Various Batches ofBHALys[Lys]₃₂[α-NH₂TFA]₃₂[ε-PEG_(~2100)]_(32‡) Number of PEGs (x) on PEGlength BHALys[Lys]₃₂[α- Estimated from CoA NH₂.TFA]₃₂[ε-PEG~₂₁₀₀]_(x)MW** Batch Scale (Da) (from proton NMR*) (kDa) 1 101   mg 2200 29 75.7 298   mg 2200 29 75.7 3 74.8  g 2100 29 72.8 4 137   mg 2200 29 75.7 51.19 g 2100 31 77.0 6 18.98 g 2100 29 72.8 *Number of PEGs is calculatedfrom the proton NMR. For batch 1: No. of PEGs = Number (integration) ofprotons in PEG region of NMR (3.4-4.2 ppm)/Average (mean) number ofprotons per PEG chain (CoA PEG/44Da x 4H)   $\quad\begin{matrix}\left. \;{= {\text{5706H/(2200/}{44\; \times \; 4}}} \right) \\{= {28.53\mspace{14mu}\left( {{{approx}.\mspace{11mu} 29}\mspace{14mu}{PEG}\mspace{14mu}{units}} \right)}}\end{matrix}$ **Molecular Weight estimated by adding MW of variouscomponents. For batch 1: $\quad\begin{matrix}{{{Total}\mspace{14mu}{MW}} = {{{Mw}\mspace{14mu}\text{of dendrimer}} + {{Mw}\mspace{14mu}{of}\mspace{14mu}{TFA}} + {{Mw}\mspace{14mu}{of}\mspace{14mu}{PEG}}}} \\{= {{{BHALys}\lbrack{Lys}\rbrack}_{32} + {32({TFA})} + {29({PEG})}}} \\{= \text{8,258 + 3,648 + 63800}} \\{= {{\sim 75.7}\mspace{14mu}{kDa}}}\end{matrix}$

TABLE 2 ¹H NMR Data for Various Batches ofBHALys[Lys]₃₂[α-NH₂TFA]₃₂[ε-PEG_(~2100)]_(32‡) Batch Scale ¹H NMR ofBHALys[Lys]₃₂[α-NH₂•TFA]₃₂[ε-PEG~₂₁₀₀]_(x) 1 101 mg 1.22-2.08 (LysCH₂(β, χ, δ), 378H), 3.00-3.26 (Lys CH₂ (α), 129H), 3.40 (PEG-OMe, 96H),3.45-4.18 (PEG-OCH₂, 5610H + Lys CH surface, 32H), 4.20-4.46 (Lys, CHinternal, 33H), 7.24-7.48 (8H, BHA). 2 98 mg As for batch 1 3 74.8 g1.02-2.18 (Lys CH₂(β, χ, δ), 378H), 2.94-3.36 (Lys CH₂ (α), 129H), 3.41(PEG-OMe, 93H), 3.45-4.18 (PEG-OCH₂, 5432H + Lys CH surface, 32H),4.18-4.50 (Lys, CH internal, 32H), 7.12-7.64 (9H, BHA). 4 137 mg As forbatch 1 5 1.19 g 1.02-2.16 (Lys CH₂(β, χ, δ), 378H), 2.93-3.36 (Lys CH₂(α), 129H), 3.41 (PEG-OMe, 101H), 3.45-4.18 (PEG-OCH₂, 5908H + Lys CHsurface, 32H), 4.18-4.50 (Lys, CH internal, 33H), 7.21-7.54 (9H, BHA). 618.98 g As for batch 3

Example 2: Synthesis of Linker-Cabazitaxel, Wherein the Linker isDiglycolic Acid (DGA) [DGA-Cabazitaxel]

To a solution of Cabazitaxel (2.00 g, 2.39 mmol) in dichloromethane (30mL, 15 vol.) was added diglycolic anhydride (320.70 mg, 2.62 mmol, 1.1eq., 95% purity). After stirring for 5 min., triethylamine (500 μL, 3.59mmol, 1.5 eq.) was added. The reaction mixture was stirred at roomtemperature for 1.5 h. LC-MS analysis (eluent: 40-80% acetonitrile inwater with 0.1% 10 mM ammonium formate buffer) showed presence of lessthan 1% starting material. The reaction mixture was diluted with 30 mLof DCM and then washed twice with sodium chloride (5%) and sodiumphosphate (1%) buffer at pH=3 (30 mL). During the first wash, the pHrose to 6.0, 1M aq. HCl (2.0 mL) was added to readjust the pH at 3.0.Layers separated. DCM extract was dried over MgSO4 (3.2 g) and filteredthrough glass sintered funnel. Funnel washed two times with 5 mL (10 mL)DCM. The filtrate was evaporated to give white solid. Yield=2.03 g,88.5%. ¹H NMR: DMSO-d₆. δ (ppm): 0.97 (s, 3H), 0.99 (s, 3H), 1.38 (s,9H), 1.46-1.60 (m, 5H), 1.77-1.85 (m, 4H), 2.23 (s, 3H), 2.62-2.75 (m,1H), 3.22 (s, 3H), 3.29 (s, 3H), 3.59 (d, J=6 Hz, 1H), 3.76 (dd, J=6 Hzand 12 Hz, 1H), 4.02 (s, 2H), 4.14 (s, 2H), 4.31 (d, J=18 Hz, 1H), 4.40(d, J=15 Hz, 1H), 4.51 (s, 1H), 4.71 (s, 1H), 4.96 (d, J=9 Hz, 1H), 5.06(t, J=9 Hz, 1H), 5.17 (d, J=6 Hz, 1H), 5.38 (d, J=9 Hz, 1H), 5.82 (t,J=9 Hz, 1H), 7.19 (t, J=9 Hz, 1H), 7.35-7.46 (m, 4H), 7.64-7.77 (m, 3H),7.88 (d, J=9 Hz, 1H), 7.98 (d, J=6 Hz, 2H). LC-MS: C8) (Bridge 3.0×100mm, 120 A, 3.5μm. 40-80% ACN/H₂O (1-7 min), 80% ACN (7-9 min), 80-40%ACN (9-11 min), 40% ACN (11-15 min), 0.1% 10 mM ammonium formate Rf(min)=5.76. ESI (+ve) observed [M+OH]⁺=969. Calculated forC₄₉H₆₁NO₁₈=952.02 Da. In process analysis: 25 μl aliquot was dilutedwith 1 ml acetonitrile. Isolated material: Approximately 1.0 mg/mlsolution in acetonitrile.

Example 3: Synthesis ofBHALys[Lys]₃₂[α-DGA-Cabazitaxel]_(32†)[ε-PEG_(˜2100)]_(32‡) (SPL9048)

PEG represents —C(O)CH₂-PEG_(˜2100) in which PEG_(˜2100) represents amethoxy-terminated PEG group having approximate average molecular weightof 2100 Daltons (e.g. an average molecular weight in the range of about1900 to 2300); and• represents a residue of Cabazitaxel.

Note: 32† relates to the theoretical number of a surface amino groups onthe dendrimer available for substitution with DGA-Cabazitaxel. Theactual mean number of DGA-Cabazitaxel groups attached to BHALys[Lys]₃₂was determined experimentally by ¹H NMR using 3,4,5-Trichloro pyridineas an internal standard.

To a solution of DGA-Cabazitaxel (2.020 g, 2.12 mmol, 1.2 eq/NH₂) in DMF(20 mL, 4.8 Vol.) was added solid PyBOP (1.15 g, 2.21 mmol, 1.25eq/NH₂). After 5 min stirring at rt, solidBHALys[Lys]₃₂[α-NH₂TFA]₃₂[ε-PEG_(˜2100)]_(32‡) (4.19 g, 55.25 μmol) wasadded. DMF (3 mL) was used to rinse residual solids from vials.Suspension was stirred at RT and mixture became homogeneous within 15min. NMM (0.97 mL, 8.84 mmol, 5 eq/NH₂) was added. A pale yellowsolution formed, and was stirred at rt for 24 h. The solution wasdiluted with ACN (24 mL) and filtered through 0.45 μm filter.BHALys[Lys]₃₂[α-DGA-Cabazitaxel]_(32†)[ε-PEG_(˜2100)]_(32‡) was isolatedby Ultrafiltration in acetonitrile (15 Diafiltration volumes) using a0.1 m² 10 kda Pelicon 3 regenerated cellulose membrane. Retentatesolution was concentrated in vacuo to give a yellow gum which wasdissolved in THF (60 mL) and was filtered through 0.45 μm filter. Thefiltrate was concentrated in vacuo to obtain a gum. The yellow gum wasdissolved in THF (27.5 ml, 4.9 vol based off theoretical yield of 5.6 gBHALys[Lys]₃₂[α-DGA-Cabazitaxel]_(32†)[ε-PEG_(˜2100)]_(32‡)) and wasadded via dropping funnel over 1 h to vigorously stirred MTBE (110 mL,20 vol), cooled in an ice bath and under N₂. A fine white suspensionformed with some clumps and some material stuck to flask walls. Onceaddition was complete, the suspension was stirred on ice for a further60 min. The flask was then removed from the ice bath and allowed to warmto rt with stirring. Solids on flask walls were mostly dislodged using aspatula and the solid was collected by filtration over a P3 sinteredfunnel. Clumps were broken using a metal spatula and the filtered solidwas washed with MTBE (2×28 mL). The wet cake was transferred to a vialand residual MTBE removed under vacuum at room temperature to afford afine white powder; 5.35 g, 94.9%. ¹H NMR: CD₃OD-d₄. δ (ppm): 1.13-2.73(m, 1225H), 3.23-3.30 (m, 57H), 3.37 (s, 99H), 3.39-3.97 (m, 5720H),4.04-4.50 (m, 114H), 5.003 (br s, 27H), 5.39-5.6.15 (m, 108H), 7.28-8.10(m, 334H). 3,4,5-Trichloro pyridine was used as internal standard andloading was calculated by comparing Cabazitaxel aromatic signals with3,4,5-trichloropyridine signals. Theoretical molecular weight ofconjugate: 102 kDa. ¹H NMR suggests 29.8 CTX/dendrimer. Actual molecularweight is approximately 100 kDa (24.9% CTX by weight). In more than 10batches manufactured, Cabazitaxel loading ranged from 24.2% to 26%. HPLC(C8 Phenomenex Kinetex 2.1×75 mm, 100 A, 2.6 μm. 5-45-90% ACN (with 0.1%TFA) in water (with 0.1% TFA) gradient: 5% (0-1 min), 5-45% ACN/H₂O (1-2min), 45% ACN (2-10 min), 45-90% (10-14 min), 90% (14-18 min), 90-5% ACN(18-18.1 min), 5% ACN (18.1-20 min) Rf (min)=14.03. In process analysis:5 μL aliquot was diluted with 1 mL acetonitrile. Isolated material:Approximately 3.0 mg/ml solution in acetonitrile.

Example 4: Efficacy of Dendrimer Compounds in SCID Mice

Example 4 compares the efficacy of dendrimer compounds in SCID mice. Inthe following Experiments and Figures:

SPL9005 is BHALys[Lys]₃₂[α-TDA-Cabazitaxel]_(32†)[ε-PEG_(˜2100)]_(32‡);and

SPL9048 is BHALys[Lys]₃₂[α-DGA-Cabazitaxel]_(32\)[ε-PEG_(˜2100)]_(32‡).

SPL9005 differs from SPL9048 in that it contains TDA (thiodiglycolyl)linking groups in place of diglycolyl linking groups (i.e. —S— in placeof —O— present in the diglycolyl linker). SPL9005 was prepared byanalogous synthetic methods to those used for the preparation of SPL9048.

References to amounts dosed in mg/kg for the dendrimeric compounds areto the amounts of Cabazitaxel that may theoretically be released by thedendrimers.

DU145 Mouse Xenograft Prostate Cancer Model Study

A DU145 mouse xenograft prostate cancer model study was carried out toassess the anti-tumour efficacy properties of SPL9048 versus comparatorcompounds. The comparator compounds were free Cabazitaxel (Jevtana®) andSPL9005 (BHALys[Lys]₃₂[α-TDA-Cabazitaxel]_(32†)[ε-PEG_(˜2100)]_(32‡)).

Dendrimer compounds were pre-weighed in glass vials and stored at 20° C.until use, and dissolved in saline immediately prior to dosing.Cabazitaxel was prepared fresh for each dosing day. An aliquot ofCabazitaxel concentrate was removed under aseptic conditions and mixedwith a 13% ethanol diluent to make up a 10 mg/ml working stock solution.Dosing solutions at 4.5 and 5.5 mg/mL were prepared from this workingstock immediately prior to injection.

Male SCID mice (age 7-8) weeks were inoculated subcutaneously in theflank with 3×10⁶ DU145 cells in PBS:Matrigel (1:1). Mice were weighedand tumours measured 2-3 times weekly using electronic callipers. Tumourvolume (mm³) was calculated as length (mm)/2×width (mm)². On day 24after implantation (referred to as Day 1), mice with similar sizedtumours (mean tumour volume 105 mm³) were randomised into 5 groups of 10animals. Treatment groups were saline, Cabazitaxel (9 and 11 mg/kg),SPL-9048 (9 mg/kg) and SPL-9005 (25 mg/kg). Test compounds were givenintravenously by tail vein injection on Days 1, 8 and 15 at 0.1 ml/10 gbody weight. Cabazitaxel was given at 0.05 ml/10 g body weight. Micereceived a small dish containing a food supplement (mixed with fooddust) daily. The experiment was ended on Day 126, or earlier if anethical endpoint was met. Survival curves were analysed using the MantelCox log rank test.

FIG. 1 shows the antitumour efficacy of the treatments against DU145tumour xenografts. Tumour volumes were determined 2-3 times weekly andare expressed as mean tumour volume (±SEM). Each group initiallyconsisted of 10 mice and graphs are shown until no fewer than 6 animalsremained in a group. As shown in FIG. 1, at the dosage administeredSPL9048 induced complete tumour regression with no regrowth observed inany of the animals on Day 126 when the experiment was concluded.

FIG. 2 shows the effect of saline, Cabazitaxel, SPL-9005 and SPL-9048 onDU145 tumour-bearing mouse body weight for male mice. Drugs wereadministered i.v. on days 1, 8 and 15 (indicated by the vertical lines).The data represent the mean percent weight change from baseline (Day 1)for each groups; bars SEM. Graphs are shown for each group until fewerthan 6 animals remained in each group.

As shown in FIG. 2, SPL9048 was overall well tolerated in mice (maxweight loss was −10% on Day 20; neutral weight loss/gain after Day 40).SPL9048 was also better tolerated than SPL9005 by male mice. ForSPL9005, 8/10 male mice had >20% weight loss after administration of athird dose on approx. day 25, but 2/10 male mice recovered to +5/10%starting weight after day 40. However, in a separate study in femaleSCID mice, when dosed at 25 mg/kg Cabazitaxel equivalent, SPL9005 wasbetter tolerated in female mice with mean weight loss being below 10%,suggesting a possible sex-related difference for this compound.

MDA-MB-231 Mouse Xenograft Breast Cancer Tumour Model Study

A MDA-MB-231 (human breast carcinoma cell line) mouse xenograft breastcancer model study was carried out to assess the anti-tumour efficacyproperties of SPL9048 versus free Cabazitaxel.

SPL-9048 was pre-weighed in glass vials and stored at 20° C. until use,and dissolved in saline immediately prior to dosing. Cabazitaxel wasprepared fresh for each dosing day. An aliquot of Cabazitaxelconcentrate was removed under aseptic conditions and mixed with a 13%ethanol diluent to make up a 10 mg/ml working stock solution. A 1.8mg/mL dosing solution was prepared from this working stock immediatelyprior to injection.

Female Balb/c nude mice (age 7 weeks) were inoculated subcutaneously onthe flank with 3.5×10⁶ MDA-MB-231 cells in PBS: Matrigel (1:1). Micewere weighed and tumours measured twice weekly using electroniccallipers. Tumour volume (mm³) was calculated as length (mm)/2×width(mm)². On day 10 after implantation (referred to as Day 1) mice withsimilar sized tumours (mean tumour volume 90 mm³) were randomised into 4groups of 10 animals. Treatment groups were saline, Cabazitaxel (9mg/kg), SPL-9048 (9 mg/kg) and SPL-9048 (10 mg/kg). All compounds weregiven intravenously by tail vein injection on days 1, 8 and 15 at 0.1ml/10 g body weight except Cabazitaxel which was given at 0.05 ml/10 gbody weight. Mice received a small dish containing a food supplement(mixed with food dust) daily. The experiment was ended on day 113 orearlier if an ethical endpoint was met.

FIG. 3 shows the antitumour efficacy of the treatments against theMDA-MB-231 tumour xenografts. Tumour volumes were determined twiceweekly and were expressed as mean tumour volume (±SEM). Each groupinitially consisted of 10 mice and graphs are shown until no fewer than7 animals remained in a group. As shown in FIG. 3, SPL9048 inducedcomplete tumour regression. Tumour regrowth in the Cabazitaxel group wasevident by day 43 with 9 of 10 tumours reaching an ethical tumour volumeendpoint by day 98. Both doses of SPL-9048 significantly extendedsurvival beyond that of Cabazitaxel.

FIG. 4 shows the effect of saline, Cabazitaxel, and SPL-9048 onMDA-MB-231 tumour-bearing mouse body weight. Each group initiallyconsisted of 10 mice. Drugs were administered i.v. on days 1, 8 and 15(indicated by the vertical lines). The data represent the mean percentweight change from baseline (Day 1) for each group; bars SEM. Graphs areshown for each group until fewer than 7 animals remained in each group.As shown in FIG. 4, SPL9048 was overall well tolerated and mean weightloss did not exceed 6% in any group.

Example 5: Toxicokinetic/Pharmacokinetic Studies

A single-dose toxicokinetic study of SPL-9048 and SPL-9005 was carriedout by intravenous bolus injection in rats with a 21-day observationperiod. The control, 0.9% sodium chloride, was prepared and dispensed onthe day of dosing. SPL-9048 and SPL-9005 were prepared at appropriateconcentrations to meet dose level requirements. The dosing formulationswere prepared and dispensed on each day of dosing and were used within 3hours of preparation. The required amount of test article was weighedout and dissolved in a suitable volume of normal saline with gentleswirling and the pH was recorded. Cabazitaxel (Jevtana®) was prepared atappropriate concentration to meet dose level requirements. The desiredamount (1.5 ml) of Cabazitaxel concentrate (40 mg/ml) was aliquotedunder aseptic conditions and dissolved in the appropriate volume (4.5mL) of 13% ethanol diluent between 15° C. and 30° C. to prepare a 10mg/mL stock solution. This stock solution was further diluted withnormal saline to produce the final dosing concentration within 30minutes.

The animals used were male and female Sprague Dawley Crl:CD (SD) rats.The animals were 10 to 14 weeks old and weighed between 327 and 565 gfor males and 212 and 316 g for females at initiation of dosing. Animalswere acclimated to their designated housing for at least 4 days beforethe first day of dosing. Animals were assigned to groups by a stratifiedrandomization scheme designed to achieve similar group mean bodyweights. Males and females were randomised separately. Animals in poorhealth or at extremes of body weight ranges were not assigned to groups.PMI Nutrition International Certified Rodent Chow No. 5CR4 was providedad libitum throughout the study except during designated procedures. Thesame diet in meal form was also provided, as needed. Municipal tapwater, after treatment by reverse osmosis and ultraviolet irradiation,was freely available to each animal via an automatic watering system,except during designated procedures. Water bottles were also provided,as required. Animal were socially housed for psychological/environmentalenrichment and were provided with items such as a chewing object, exceptwhen interrupted by study procedures/activities. Veterinary care wasavailable throughout the course of the study.

The test and control articles were administered to the appropriateanimals at the amounts indicated in the table below via a singleintravenous (slow bolus) injection to the tail vein. References toamounts dosed in mg/kg for the dendrimeric compounds SPL-9048 andSPL-9005 are to the amounts of Cabazitaxel that may theoretically bereleased by the dendrimers.

Animals were observed for 21 days following dose administration. Thedose volume for each animal was based on the most recent body weightmeasurement. The animals were temporarily restrained for doseadministration and were not sedated. The doses were given using asyringe with attached needle. The first day of dosing for each group wasdesignated as Day 1. The comparator dosing formulation (Jevtana®,Cabazitaxel) and test articles were maintained between 15 and 30° C.during dosing.

Number of Dose Level Animals (Cabazitaxel Dose Dose Toxicokinetic TestEquivalents) Volume Concentration Study Material (mg/kg) (mL/kg) (mg/mL)Males SPL9048 1 1 1 6 SPL9048 2.5 1 2.5 6 SPL9005 1 1 1 6 SPL9005 2.5 12.5 6 Jevtana 2.5 1 2.5 6

Toxicokinetic parameters were estimated using Phoenix pharmacokineticsoftware. A non-compartmental approach consistent with the intravenousroute of administration was used for parameter estimation. Allparameters were generated from SPL9048, SPL9005, and Jevtana®(Cabazitaxel) composite concentrations in plasma whenever practical.

The table below and FIG. 5 provide details regarding the pharmacokineticparameters for free Cabazitaxel following administration of SPL9048 (aCabazitaxel-containing dendrimer of the present disclosure, orcomparator compounds, i.e. SPL9005 (a different Cabazitaxel-containingdendrimer) and Jevtana® (Cabazitaxel).

FREE(unconjugated)-(Cabazitaxel) Dose Level % (drug eq., Cmax TmaxAUC_(0-t) Jevtana ® Treatment mg/kg) Sex (ng/mL) (h) (ng · h/mL) doseSPL9048 - 1 Males 14.13 2 445.00 65 1 mg/kg (Tk) SPL9048 - 2.5 Males36.89 6 1239.99 182 2.5 mg/kg (Tk) SPL9005 - 1 Males 4.41 6 202.94 30 1mg/kg (Tk) SPL9005 - 2.5 Males 9.29 2 548.96 81 2.5 mg/kg (Tk) Jevtana ®2.5 Males 801.05 2 min 679.99 100 (cabazitaxel) - 2.5 mg/kg (Tk)

The free Cabazitaxel plasma profile for SPL9005 and SPL9048 wasdistinctly different from that for Jevtana®. The results show thatadministration of SPL9048 at 2.5 mg/kg resulted in a Cmax value of 36.89ng/mL, a Tmax value of 6 hours, and an area under the curve (AUC) of1239.99 ng·h/mL. Administration of SPL9005 at 2.5 mg/kg resulted in aCmax of 9.29 ng/mL, a Tmax of 2 hours, and an AUC of 548.96 ng·h/mL.Administration of Jevtana® at 2.5 mg/kg resulted in a Cmax value of801.05 ng·h/mL, a Tmax of 2 min and an AUC of 679.99 ng h/mL. For theJevtana® group, Cabazitaxel was not measurable more than 24 hours afterJevtana® administration.

Thus, administration of SPL9048 results in reduced risk of side effectsor toxicity compared with Jevtana® due to the considerably lower Cmax.Administration of SPL9048 also resulted in increased overall exposure toCabazitaxel compared to Jevtana®, as shown by the AUC values in theabove table. Both SPL-9048 and SPL-9005 have a lower Cabazitaxel Cmaxthan administration of a comparable amount of Jevtana®. However, theamount of free Cabazitaxel delivered by SPL9048 over the time course ofthe study was higher than that delivered by a comparable dose of SPL9005(i.e. containing an equivalent amount of Cabazitaxel), as demonstratedby the AUC levels (see Table and FIG. 4). SPL9048 demonstrated anexcellent pharmacokinetic profile consistent with reduced likelihood ofside effects and increased efficacy at equivalent dose.

Example 6: Toxicology Studies

Toxicology studies in rats were carried out comparing the effects ofSPL9048 and free Cabazitaxel (Jevtana®).

SPL9048 and Jevtana® were dosed at 1 mg/kg to rats, n=6 (3 males, 3females). References to amounts dosed in mg/kg for the dendrimericcompound are to the amounts of Cabazitaxel that may theoretically bereleased by the dendrimer.

As shown in FIG. 6, the results show that there is a separation inneutropenia at this dosage level (1 mg/kg) in both male and female rats,as evidenced by the dip in values seen with the administration ofJevtana® (i.e. Cabazitaxel) and a lesser/no dip in values observedfollowing administration of SPL9048 (see day 7 in particular). Therebound after day 7 appears to depend on the severity of neutropenia, aswould be expected. In the 1 mg/kg Jevtana® (i.e., free Cabazitaxel)groups, there is a substantial rebound at day 14, whereas there isvirtually no rebound in the 1 mg/kg SPL9048 groups (or controls), whichis consistent with limited neutropenia in these groups. This indicatesthat SPL9048 is likely to induce less neutropenia, and therefore be lesstoxic in the clinic, compared with the administration of an equivalentdose of free Cabazitaxel.

Similar results were also found in a study at which SPL9048 and Jevtana®were delivered at 2.5 mg/kg active agent. SPL9048 was found to be lessneutropenic at day 5 than Jevtana®. Reduced toxicity was observed forSPL9048 compared to Jevtana®/Cabazitaxel. Test articlerelated-hematology changes (decreases in white blood cells, neutrophils,lymphocytes, monocytes, eosinophil, platelets, and reticulocytes) werenoted at 2.5 mg/kg SPL9048 and 2.5 mg/kg Jevtana® by Day 2 in males andfemales and remained low through Day 7. The decreases in theseparameters were generally greater in rats administered 2.5 mg/kgJevtana®.

Treatment-related microscopic changes were observed in the thymus, bonemarrow, and spleen in animals administered SPL9048 at 2.5 mg/kg andJevtana® at 2.5 mg/kg; the severity of the bone marrow and thymusfindings was generally greater in Jevtana®-treated rats.

Example 7: Comparative Linker Release Rates in PBS at 37° C. and pH 7.4

A study was carried out to determine the rate of Cabazitaxel releasefrom certain dendrimeric compounds in PBS (phosphate-buffered saline) at37° C. and pH 7.4. The compounds tested were:

i) compounds of the present disclosure, SPL9048 and SPL9049(BHALys[Lys]₃₂[α-DGA-Cabazitaxel]_(32†)[ε-PEG_(˜1100)]_(32‡). SPL9049differs from SPL9048 in that it contains lower molecular weight PEGgroups; and

ii) comparator Cabazitaxel-containing dendrimeric compounds, SPL9005 andSPL9006 (SPL9006 differs from SPL9048 in that it contains MIDA(Methyliminodiacetyl) linking groups in place of diglycolyl linkinggroups (i.e. —N(Me)- in place of —O— present in the diglycolyl linker.SPL9006 was prepared by analogous synthetic methods to those used forthe preparation of SPL 9048).

Results indicating the % Cabazitaxel released at 24 hours for two repeatexperiments are shown in the table below, together with the mean time to50% release (or estimated mean time to 50% release based on datapoints):

-   -   % of Cabazitaxel released in PBS at 37° C. and pH 7.4:

% API released % API released at 24 hours at 24 hours Time to 50%release (Exp #1) (Exp #2) (mean) (Exp #2) SPL9005 11.9 15 Estimated at5-7 days SPL9006 7.5 8 Estimated at 6-8 days SPL9048 37 41 36 hoursSPL9049 51.5 32 54 hours

Data for SPL9048 and SPL9049 at additional timepoints in Exp #2 is alsoprovided below:

-   -   % of Cabazitaxel released in PBS at 37° C. and pH 7.4:

time (h) SPL9049 SPL9048 0 0.97 0.95 24 32.06 41.28 48 45.156 55.48 6759.676 62.65 87 67.86 71.12

The results demonstrate the relative release rates of Cabazitaxel fromthe dendrimer following administration. The comparator SPL9005 resultsin the release of about 12 to 15% Cabazitaxel over 24 hours in PBS at37° C. and pH 7.4, the comparator SPL9006 (MIDA linker) results in therelease of about 8% Cabazitaxel in PBS at 37° C. and pH 7.4 over thesame time period, the compound of the present disclosure SPL9048 resultsin the release of about 40% Cabazitaxel in PBS at 37° C. and pH 7.4 overa 24-hour period, and SPL9049 results in the release of about 30 to 50%Cabazitaxel under the same conditions.

SPL9048 has also been observed to have increased stability in solution(e.g. with regard to precipitation) compared with SPL9049, which may beattributed to the conjugate containing a PEG₂₂₀₀ group rather than aPEG₁₁₀₀ group. Alongside the excellent efficacy, toxicokinetic andpharmacokinetic properties observed for SPL9048, this property is afurther advantage for that drug-dendrimer conjugate.

Example 8: Stability of Citric Acid Drug-Dendrimer Conjugate Composition

A study conducted on drug release on dendrimer molecules containing adifferent pharmaceutical agent, in 0.1M citric acid at pH 3.5 to 6.5identified greatest stability over 7 days at pH 4.5 at room temperatureand 4 degrees Celsius. The optimal range was 3.5 to 5.5 with less than0.3% and 0.1% release at RT and 4 C respectively. Another study wasconducted to evaluate 10 different inhibitors of drug release ondendrimer molecules containing a different pharmaceutical agent in dog,mouse and human plasma. Citric acid was identified as the most effectiveinhibitor of drug release.

Example 9: Comparison of SPL9048 to Abraxane® and Gemcitabine

A CAPAN-1 (human pancreatic adenocarcinoma cell line) mouse xenograftpancreatic cancer model study was carried out to assess the anti-tumourefficacy properties of SPL9048 compared to Abraxane® (albumin boundpaclitaxel), alone or in combination with Gemcitabine.

SPL9048 and Cabazitaxel were prepared as described above. Gemcitabineand Abraxane® were obtained from the Peter MacCallum Cancer Centrepharmacy, and were dissolved in saline solution immediately prior todosing.

Female NOD-SCID Interleukin-2 receptor gamma chain null mice (aged 9weeks) were inoculated subcutaneously on the flank with 5×10⁶ CAPAN-1cells in PBS:Matrigel (1:1). Mice were weighed and tumours measuredtwice weekly using electronic callipers. Tumour volume (mm³) wascalculated as length (mm)/2×width (mm)². On day twenty-six afterimplantation, mice with similar sized tumours (mean tumour volume 100mm³) were randomised into 8 groups of 9 animals.

Abraxane® and SPL9048 were administered via tail vein i.v. injection,and gemcitabine was administered by i.p. injection on days 1, 8 and 15at 0.1 ml/10 g body weight. The experiment was ended on day 107 orearlier if an ethical endpoint was met. One mouse died immediately afterinjection with Abraxane® on day 1 due to an injection error. All othertreatments were well tolerated with no weight loss. Tumour growth datawas analysed in GraphPad Prism for ANOVA followed by Dunnett's postad-hoc test. Groups were dosed as follows:

1. Saline—vehicle2. Gemcitabine (80 mg/kg, i.p.)—vehicle (saline)3. Abraxane® (40 mg/kg, i.v.)—vehicle4. Abraxane® (40 mg/kg, i.v.)+Gemcitabine (80 mg/kg, i.p.)7. SPL9048 (7.5 mg/kg, i.v.)—vehicle8. SPL9048 (7.5 mg/kg, i.v.)+Gemcitabine (80 mg/kg, i.p.)

FIG. 7 shows the anti-tumour efficacy of the treatments against theCAPAN-1 tumour xenografts. Tumour volumes were determined twice weeklyand are expressed as mean tumour volume (±SEM). As shown in FIG. 7,SPL9048, given alone or in combination with Gemcitabine, inducedcomplete regression of CAPAN-1 tumours for the duration of the study.Neither Gemcitabine or Abraxane® were effective in this model. SPL9048treatment inhibited CAPAN-1 tumour growth more effectively thanAbraxane® (P=0.004, Abraxane® vs SPL-8732; P<0.0001 Mantel Coxregression analysis of Kaplan-Meier survival curves).

Abraxane®, administered alone and in combination with Gemcitabine,inhibited CAPAN-1 tumour growth to a similar extent (percent tumourgrowth inhibition on Day 37=85% and 81%, respectively; Table 2). SPL9048significantly extended survival beyond that of Gemcitabine or Abraxane®.

Tumour Growth Treatment inhibition (%) P (vs vehicle) Gemcitabine 40<0.0001 Abraxane ® 85 <0.0001 SPL9048 107 <0.0001 Abraxane ® +Gemcitabine 81 <0.0001 SPL9048 + Gemcitabine 109 <0.0001

Analysis was performed on Day 37, the last day all vehicle treatedanimals remained in the study.

Example 10: Phase 1 Clinical Study—PK and Biomarkers

A phase 1 dose escalation study was conducted to determine appropriatedosages of SPL9048. Biomarker, PK and other data were collected frompatients enrolled in the study. Patients were dosed every 3 weeks, over1 hour using an infusion pump. Patients all had progressive metastaticdisease. The patient population was heavily pre-treated with a range ofchemotherapeutic agents as described in the below table.

Prior Medicaments Cancer Type Androgen deprivation therapy ProstateLuteinizing hormone-releasing hormone agonist Bicalutamide EnzalutamideDocetaxel (up to two cycles) Docetaxel/G-CSF (up to six cycles)Carboplatin/Paclitaxel/Bevacizumab (one cycle) OvarianCarboplatin/Paclitaxel (up to seven cycles) Bevacizumab (up to 18cycles) Gemcitabine/Carboplatin Niraparib Folfirinox ® (folinicacid/fluorouracil/irinotecan/ Pancreatic oxaliplatin) (up to 10 cycles)Gemcitabine/Capecitabine (up to two cycles) Gemcitabine/Abraxane (up to16 cycles) Gemcitabine (up to two cycles)

The data in FIGS. 8 and 9 shows that the biomarker response occurs atdoses of SPL9048 as low as 10 mg/m². FIG. 8 shows PSA, a prostate cancermarker, declining in prostate cancer patients after multiple doses at 10mg/m² and continuing at 20 mg/m² Cabazitaxel equivalents. FIG. 9 showsCA-125, an ovarian cancer marker, declining after two doses at 15 mg/m².These are important signs of efficacy.

The following table identifies the patients of the study, many showingsigns of stable disease.

Dose Range Tumour Type (mg/m² No. of (stage at Cabazitaxel) Cyclesscreening) Positive Treatment Response 2 to 15 12 Digital papillaryStable disease >33 weeks. adenocarcinoma (stage IV) 5 to 20 13 ProstateStable disease >35 weeks. (stage III) PSA declined from 106 to 25 μg/L(over 12 weeks), (see FIG. 7) 15 to 20 7 Ovarian CA-125 declining (60%)from (stage IV) 652 to 255 kU/L (over 15 weeks) after one cycle at 15mg/m² dose. (see FIG. 8) 20 5 Prostate PSA declined (67%) from 262 to 86μg/L (in 3 weeks) after three cycles, following rising PSA. Preliminarysigns of PSA stability at 5 mg/m². Stable disease >6 weeks 20 1Pancreatic Stable CA 19-9, abdominal adenocarcinoma pain subsided andcessation of opioid treatment after one cycle. 20 3 Pancreatic CA 19-9declining (28%) adenocarcinoma from 177 baseline to (stage IV) 127 kU/Lafter one cycle.

Pharmacokinetic data relating to the free Cabazitaxel from the study isshown in the Table below. In summary, after administration with SPL9048,free Cabazitaxel Cmax is about 3- to 10-fold less than Jevtana® atequivalent Cabazitaxel dose of 20 mg/m². Cmax at 20 mg/ml Cabazitaxelequivalents in the three patients was measured as 53.6, 15.8, and 17.6ng/ml.

Dose (μg/m² T_(1/2) Free Cabazitaxel Cmax AUCinf (terminal) Cabazitaxelequivalents) (ng/ml) (ng/ml*h) (h) SPL9048 15 15; 11 1370; 1700 195; 107(Jevtana ®) (137) (569) (90) SPL9048 20 53.6; 15.8; 17.6  745; 1020 48;81 (Jevtana ®) (183) (759) (90)

Pharmacokinetic data relating to the total Cabazitaxel (i.e freeCabazitaxel and dendrimer-bound Cabazitaxel) from the study is shown inthe Table below. In summary, the total Cabazitaxel AUCinf afteradministration with SPL9048 is about 2000 to 4000 times greater thanJevtana® at equivalent Cabazitaxel dose.

T_(1/2) Total Dose Cmax AUCinf (terminal) Cabazitaxel (mg/m²) (ng/ml)(ng/ml*h) (h) SPL9048 15 8020; 8610  176,000; 182,000 116; 15(Jevtana ®) (137) (569) (90) SPL9048 20 8,050; 10,100 159,000; 222,00012; 13 (Jevtana ®) (183) (759) (90)

Jevtana® numbers calculated using model described in Ferron G., et alCancer Chemo Pharma (2013) 71:681-692.

1. A method of treating a cancer comprising administering to a subjectin need thereof a therapeutically effective amount of a dendrimercomprising: i) a core unit (C); and ii) building units (BU), eachbuilding unit being a lysine residue or an analogue thereof; wherein thecore unit is covalently attached to two building units via amidelinkages, each amide linkage being formed between a nitrogen atompresent in the core unit and the carbon atom of an acyl group present ina building unit; the dendrimer being a five generation building unitdendrimer; wherein building units of different generations arecovalently attached to one another via amide linkages formed between anitrogen atom present in one building unit and the carbon atom of anacyl group present in another building unit; iii) a plurality of firstterminal groups (T1) comprising a cabazitaxel residue covalentlyattached to a diglycolyl linker group; and iv) a plurality of secondterminal groups (T2) comprising a PEG or PEOX group; wherein at leastone third of the nitrogen atoms present in outer building units are eachcovalently attached to a first terminal group; and at least one third ofthe nitrogen atoms present in outer building units are each covalentlyattached to a second terminal group; and wherein the therapeuticallyeffective amount of dendrimer administered to the subject provides about20 mg/m² of cabazitaxel.
 2. The method as claimed in claim 1, whereinthe core is:


3. The method as claimed in claim 1, wherein the building units areeach:

wherein the acyl group of each building unit provides a covalentattachment point for attachment to the core or to a previous generationbuilding unit; and wherein each nitrogen atom provides a covalentattachment point for covalent attachment to a subsequent generationbuilding unit, a first terminal group or a second terminal group.
 4. Themethod as claimed in claim 1, wherein each first terminal group (T1) is:


5. The method as claimed in claim 1, wherein the second terminal groupsare each

and wherein the PEG group is a methoxy-terminated PEG having an averagemolecular weight in the range of from about 1750 to 2500 Daltons.
 6. Themethod as claimed in claim 1, wherein the dendrimer comprises surfaceunits comprising an outer building unit attached to a first terminalgroup and a second terminal group, the surface units having thestructure:


7. The method as claimed in claim 6, wherein the dendrimer has from 28to 32 surface units, preferably from 30 to 32 surface units.
 8. Themethod as claimed in claim 1, wherein the five generations of buildingunits are complete generations, and wherein the outer generation ofbuilding units provides 64 nitrogen atoms for covalent attachment to afirst terminal group or a second terminal, wherein from 26 to 32 firstterminal groups are covalently attached to one of said nitrogen atoms,and wherein from 28 to 32 second terminal groups are each covalentlyattached to one of said nitrogen atoms.
 9. The method as claimed inclaim 1, wherein the cabazitaxel residues comprise a w/w % of thedendrimer in the range of from 23% w/w to 28% w/w.
 10. The method asclaimed in claim 1, wherein the dendrimer is:

in which T1′ represents a first terminal group which is

or T1′ represents H, wherein less than 5 of T1′ are H; and T2′represents a second terminal group which is

wherein the PEG group is a methoxy-terminated PEG having an averagemolecular weight in the range of from about 1750 to 2500 Daltons, or T2′represents H, and wherein less than 5 of T2′ are H.
 11. The method ofclaim 1, wherein the cancer is selected from the group consisting ofpancreatic cancer, prostate cancer, breast cancer, ovarian cancer,gastro-oesophageal cancer, thymic cancer, hepatobiliary cancer, head andneck squamous cell carcinomas, non-small cell lung carcinoma, cervicalcancer, and digital papillary adenocarcinoma.
 12. The method of claim11, wherein the ovarian cancer is a granulosa cell cancer.
 13. Themethod of claim 11, wherein the gastro-oesophageal cancer is agastro-oesophageal junction adenocarcinoma or an oesophageal squamouscell carcinoma.
 14. The method of claim 11, wherein the hepatobiliarycancer is a cholangiocarcinoma.
 15. The method of claim 11, wherein theprostate cancer is selected from the group consisting of bone metastaticprostate cancer, prostatic neoplasms, hormone-refractory prostatecancer, metastatic castration-resistant prostate cancer, and advancedprostate cancer.
 16. The method of claim 15, wherein the prostate canceris metastatic castration-resistant prostate cancer.
 17. The method asclaimed in claim 1, wherein the dendrimer is administered as an infusionover a time period of up to 60 minutes, or wherein the dendrimer isadministered as a bolus over a time period of up to 5 minutes.
 18. Themethod as claimed in claim 1, wherein the dendrimer is administered incombination with a further therapeutic agent.
 19. The method as claimedin claim 18, wherein the further therapeutic agent is a furtheranti-cancer drug.
 20. The method as claimed in claim 1, whereinadministration of the dendrimer provides enhanced clinical efficacy incomparison to administration of 20 mg/m² of free cabazitaxel.
 21. Themethod as claimed in claim 1, wherein administration of a course of thedendrimer provides enhanced clinical efficacy in comparison tothree-weekly administration of 20 mg/m² of free cabazitaxel.
 22. Themethod as claimed in claim 1, wherein administration of the dendrimerprovides a reduction in a side effect selected from the group consistingof alopecia, leukopenia, asthenia, haematuria, neutropenia, lymphopenia,anemia, and thrombocytopenia, in comparison to administration of 20mg/m² of free cabazitaxel.
 23. The method as claimed in claim 22,wherein administration of the dendrimer provides a reduction in a Grade3 or 4 side effect/adverse effect.
 24. The method as claimed in claim22, wherein the administration of the dendrimer provides a reduction inneutropenia in comparison to administration of 20 mg/m² of freecabazitaxel.
 25. The method as claimed in claim 1, wherein the subjecthas not received primary granulocyte colony stimulating factor (G-CSF)prophylaxis.
 26. The method as claimed in claim 1, wherein the age ofthe subject is at least about 65, about 70, or about 80 years.
 27. Themethod of claim 26, wherein the age of the subject is at least about 65years.
 28. The method as claimed in claim 1, wherein the cancer ismetastatic castration-resistant prostate cancer and the subject has notreceived primary granulocyte colony stimulating factor (G-CSF)prophylaxis.
 29. The method as claimed in claim 28, wherein the age ofthe subject is at least about 65 years.
 30. The method as claimed inclaim 1, wherein the dendrimer is administered as a pharmaceuticalcomposition.
 31. The method as claimed in claim 30, wherein thepharmaceutical composition comprises a pharmaceutically acceptableexcipient.
 32. The method as claimed in claim 31, wherein thecomposition further comprises trehalose and citric acid.
 33. A processfor producing a dendrimer as claimed in claim 1, comprising: a) reactinga cabazitaxel intermediate which is:

wherein X is —OH or a leaving group, or wherein X together with the C(O)group to which it is attached forms a carboxylate salt; with adendrimeric intermediate which comprises: i) a core unit (C); and ii)building units (BU), each building unit being a lysine residue or ananalogue thereof; wherein the core unit is covalently attached to twobuilding units via amide linkages, each amide linkage being formedbetween a nitrogen atom present in the core unit and the carbon atom ofan acyl group present in a building unit; the dendrimer being a fivegeneration building unit dendrimer; wherein building units of differentgenerations are covalently attached to one another via amide linkagesformed between a nitrogen atom present in one building unit and thecarbon atom of an acyl group present in another building unit; thedendrimer further comprising: a plurality of second terminal groups (T2)each comprising a PEG group; wherein at least one third of the nitrogenatoms present in the outer building units are each covalently attachedto a second terminal group; and wherein at least one third of thenitrogen atoms present in the outer building units are unsubstituted andavailable for reaction with the first intermediate; or a salt thereof;under amide coupling conditions; or b) reacting a PEG intermediate whichis:

wherein PEG Group is a PEG-containing group, and X is —OH or a leavinggroup, or wherein X together with the C(O) group to which it is attachedforms a carboxylate salt; with a dendrimeric intermediate whichcomprises: i) a core unit (C); and ii) building units (BU), eachbuilding unit being a lysine residue or an analogue thereof; wherein thecore unit is covalently attached to two building units via amidelinkages, each amide linkage being formed between a nitrogen atompresent in the core unit and the carbon atom of an acyl group present ina building unit; the dendrimer being a five generation building unitdendrimer; wherein building units of different generations arecovalently attached to one another via amide linkages formed between anitrogen atom present in one building unit and the carbon atom of anacyl group present in another building unit; the dendrimer furthercomprising: a plurality of first terminal groups (T1) each comprising acabazitazel residue covalently attached to a diglycolyl linker group;wherein at least one third of the nitrogen atoms present in the outerbuilding units are each covalently attached to a first terminal group;and wherein at least one third of the nitrogen atoms present in theouter building units are unsubstituted; or a salt thereof; under amidecoupling conditions; or c) reacting a surface unit intermediate whichis:

wherein PEG Group is a PEG-containing group, and X is —OH or a leavinggroup, or wherein X together with the C(O) group to which it is attachedforms a carboxylate salt; with a dendrimeric intermediate comprising: i)a core unit (C); and ii) building units (BU), each building unit being alysine residue or an analogue thereof; wherein the core unit iscovalently attached to two building units via amide linkages, each amidelinkage being formed between a nitrogen atom present in the core unitand the carbon atom of an acyl group present in a building unit; thedendrimeric intermediate being a four generation building unitdendrimeric intermediate; wherein building units of differentgenerations are covalently attached to one another via amide linkagesformed between a nitrogen atom present in one building unit and thecarbon atom of an acyl group present in another building unit; andwherein nitrogen atoms present in the outer building units of thedendrimeric intermediate are unsubstituted; or a salt thereof; underamide coupling conditions.
 34. An intermediate for producing a dendrimerwhich is:

wherein X is —OH or a leaving group, or wherein X together with the C(O)group to which it is attached forms a carboxylate salt.
 35. Anintermediate for producing a dendrimer which is

wherein PEG Group is a PEG-containing group, and X is —OH or a leavinggroup, or wherein X together with the C(O) group to which it is attachedforms a carboxylate salt.